DES in the Treatment of Rape Victims
Prevention of Pregnancy, 1975
Post-coital prevention of pregnancy should be attempted in victims of childbearing age who are likely to be fertile, who are at a vulnerable time in their menstrual cycle, and who do not have contraceptive protection. Diethylstilbestrol, 25 mg orally twice daily for five days is prescribed. Because nausea is a frequent side effect, an antiemetic is of benefit prophylactically.
The patient was also given a prescription for diethylstilbestrol (DES) to prevent pregnancy. It is an interesting historical note that this medication, experimentally effective in preventing pregnancy in laboratory animals, received its first human trial among rape victims. Kuchera2 administered DES within 72 hours of unprotected intercourse in 1,000 women at the University of Michigan Health Center. There were no pregnancies. This case illustrates the importance of disseminating health information to the public. This patient would never have come to our Emergency Room had she not been aware of the efficacy of DES.
What are the side effects of DES and are we worried about subsequent vaginal adenocarcinoma in the victim’s female offspring should the victim become pregnant?
First, the term “morning after pill” is a misnomer. Actually you must take 25 mg twice daily for five days. In light of the frequent nausea, some women do not complete the course and thus do have an increased risk of pregnancy. Nausea can be treated with an antiemetic such as prochlorperazine (Compazine®). Your point about vaginal adenocarcinoma in female offspring is well taken. While recent work has linked DES with higher than expected rates of vaginal adenocarcinoma in female offspring of the recipients of the drug, its actual occurrence is rare.3 Nevertheless, we customarily advise the victim that if she takes DES and becomes pregnant an abortion is indicated. DES is withheld if a menstrual history suggests the possibility of pregnancy prior to the assault, or if the victim is uncertain if she would have an abortion.
- Total health needs of the rape victim, The Journal of family practice, jfp-archived-issues, 1975 June.
- Image credit mirror.