1. Presentation # P2 655 Yohimbine in women with hypothyroidism and sexual dysfunction Bharti Kalra, Sonia Nagpal, Sanjay Kalra BHARTI HOSPITAL, KARNAL

2. BACKGROUND SEXUAL DYSFUNCTION IS COMMONER IN WOMEN THAN IN MEN (Laumann EO et al, 1999) The commonest disorders are orgasm and arousal in community surveys; desire and arousal in OPD surveys. LITTLE ATTENTION IS PAID TO THIS ASPECT OF WOMENS HEALTH Even less attention is paid to this aspect in women with hypothyroidism

3. STUDIES IN INDIA WOMEN EXPECT, AND APPRECIATE, COUNSELLING REGARDING SEXUALITY AS A PART OF ROUTINE CARE (Kalra B et al, Diabetes, 2006; Kalra B et al, Diabetologia, 2006)

4. DIAGNOSTIC TOOLS FEMALE SEXUAL FUNCTION INDEX (Rosen R et al,2000; 2005) Brief multidimensional self-reporting validated questionnaire Assesses domains of desire, arousal, lubrication, orgasm, satisfaction and pain. Validated in English, not in Indian languages

5. SOUTH ASIAN TRANSLATIONS DESIRE AROUSAL ORGASM SATISFACTION PAIN LUBRICATION PENETRATION iccha uttejna, josh sukoon, tripti, nasha, pani chootna mazaa,santushti dard chiknapan sambhog

6. STUDY DESIGN prospective, open-label, case- control, unicentre study, to assess the effect of yohimbine in women with hypothyroidism and sexual dysfunction.

7. SUBJECT POPULATION 100 women with hypothyroidism, aged 18 to 45 were administered the FSFI questionnaire 58 scored < 26.50, indicative of sexual dysfunction 30 subjects were given yohimbine 6 mg h.s. orally for 1 month along with sexual counseling. The control group (n=28) received counseling but no drug therapy. Informed verbal consent taken from all subjects

8. Yohimbine Indole alkylamine alkaloid Bark of tree Pausinystalia yohimbe Root of Rauwolfia structure resembles that of reserpine; actions are opposite to those of clonidine Competitive selective Alpha-2 adrenergic receptor antagonist

9. Yohimbine Shotgun approach Profound effect on sexual behaviour –Post-synaptic α2 adrenoceptor antagonist –central noradrenergic activity –serotoninergic potentiation –Readily enters CNS –Has peripheral and central actions –Encourages sympathetic outflow

10. Use of yohimbine Max 200 mg/d Average dose 6 to 10 mg/d Tolerance: initial enhanced response followed by decline in effect t½ = 35 mins h.s. vs. t.d.s vs p.r.n

11. SUBJECT POPULATION CHARACTERISTICCONTROL GROUPSTUDY GROUP AGE (y) 39.00 ± 4.0436.76 ± 5.38 DURN OF HYPOTHYROIDISM (y) 5.00 ± 2.536.53 ± 2.93 MARRIED FOR (y) 15.41 ± 5.0312.15 ± 4.84 Sens neuropathy (%) 50.0%53.8% HYPERTENSION (%) 20.8%23.1% HYPERLIPIDEMIA(%) 12.5%23.1%

12. RESULTS Arousal, desire, orgasm, satisfaction and total scores rose significantly in the study group, while there was an insignificant rise in pain and lubrication scores. Frequency of sexual contact increased more significantly in yohimbine group.

13. STUDY GROUP PREPOST Desire*2.40 ± 0.883.80 ± 1.43 Lubrication3.70 ± 1.905.10 ± 0.51 Orgasm*2.90 ± 2.323.80 ± 2.05 Satisfaction*4.50 ± 2.285.80 ± 0.60 Pain3.90 ± 2.504.80 ± 1.04 Arousal*2.50 ±1.704.70 ± 1.11 Total*30.60 ± 29.3076.60 ± 10.10 Freq of contact2.0 ± 0.0/week3.0 ± 1.2/week * = P <0.05

14. Chart for study group

15. CONTROL GROUP PREPOST Desire*2.50 ± 0.743.00 ± 0.80 Lubrication2.40± 2.142.70 ± 0.63 Orgasm2.80 ± 2.024.50 ± 0.87 Satisfaction4.55 ± 2.085.50 ± 0.64 Pain3.90 ± 2.504.60 ± 0.14 Arousal2.08 ±1.223.50 ± 0.95 Total*30.00 ± 29.1058.30 ± 26.60 Freq of contact2.0 ± 1.2/week2.6 ± 1.2/week * = P <0.05

16. Chart for control group

17. CONCLUSION Yohimbine is thus a useful drug for management of sexual desire and orgasm disorders in women with hypothyroidism. It improves arousal and satisfaction significantly, while contributing to an insignificant improvement in lubrication.