Effect of yohimbine on sexual disorders in women with diabetes

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Effect of yohimbine on sexual disorders in women
with diabetes

• Bharti Kalra, Sonia Nagpal,
  Sanjay Kalra, Pooja Batra
• BHARTI HOSPITAL, KARNAL

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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.

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PRESENT STATUS

• LITTLE ATTENTION IS PAID TO THIS ASPECT OF
  WOMENS HEALTH
• Even less attention is paid to this aspect in
  women with diabetes
• ? Gender-bias
• ? Lack of training/communication skills
• ? Lack of diagnostic tools
• ? Lack of treatment options

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STUDIES IN INDIA

• FEMALE SEXUAL DYSFUNCTION IS COMMON IN WOMEN WITH
  DIABETES
• WOMEN EXPECT, AND APPRECIATE, COUNSELLING
  REGARDING SEXUALITY AS A PART OF ROUTINE DIABETES
  CARE (Kalra B et al, Diabetes, 2006 Kalra B et
  al, Diabetologia, 2006)

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AVAILABLE DRUGS

• Counselling and reassurance
• Sulbutiamine
• DHEA
• Estrogens
• Androgens
• Tibolone
• Yohimbine
• Sildenafil

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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

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CLASSIFICATION DSM-IV-TR

• DESIRE
• Hypoactive
• Aversion
• AROUSAL
• ORGASM
• PAIN
• Vaginismus
• Dyspareunia

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TRANSLATIONS

• DESIRE
• AROUSAL
• ORGASM
• SATISFACTION
• PAIN
• LUBRICATION
• PENETRATION

• iccha
• uttejna, josh
• sukoon, tripti, nasha, pani chootna
• mazaa,santushti
• dard
• chiknapan
• sambhog

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STUDY DESIGN

• prospective,
• open-label,
• case- control,
• unicentre study,
• to assess the effect of yohimbine in women with
  diabetes and sexual dysfunction.

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SUBJECT POPULATION

• 26 female subjects with type 2 diabetes and
  sexual disorder, aged 18 to 45, (quantitated
  using FSFI questionnaire), were given yohimbine 6
  mg h.s. orally for 1 month along with sexual
  counseling.
• The control group (n24) received counseling but
  no drug therapy.
• Informed verbal consent taken from all subjects

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Yohimbine

• Indole alkylamine alkaloid
• Bark of tree Pausinystalia yohimbe
• Root of Rauwolfia
• structure resembles that of reserpine actions
  are opposite to those of clonidine

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yohimbine

• Competitive selective Alpha-2 adrenergic receptor
  antagonist
• Readily enters CNS
• Has peripheral and central actions
• Encourages sympathetic outflow
• Potentiates release of norepinephrine

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yohimbine

• Sexual dysfunction
• Orthostatic hypotension
• Diabetic neuropathy
• Dry mouth
• Alzheimers disease
• Analgesia

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yohimbine

• Shotgun approach
• Profound effect on sexual behaviour
• Post-synaptic a2 adrenoceptor antagonist
• central noradrenergic activity
• serotoninergic potentiation

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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

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SUBJECT POPULATION
CHARACTERISTIC CONTROL GROUP STUDY GROUP
AGE (y) 39.00 4.04 36.76 5.38
DURN OF DIABETES (y) 5.00 2.53 6.53 2.93
DURN OF NEUROPATHY (y) 0.69 0.75 0.69 0.75
MARRIED FOR (y) 15.41 5.03 12.15 4.84
Sens neuropathy () 50.0 53.8
HYPERTENSION () 20.8 23.1
HYPERLIPIDEMIA() 12.5 23.1
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Domains studied

• DESIRE
• AROUSAL
• LUBRICATION

• ORGASM
• SATISFACTION
• PAIN
• TOTAL

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RESULTS

• Desire, lubrication, orgasm, satisfaction and
  total scores
  rose significantly
  
  in the study group, while
  there was
  an insignificant rise in pain and arousal
  scores.

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STUDY GROUP
PRE POST
Desire 2.50 1.08 3.80 1.43
Lubrication 3.70 1.90 5.10 0.51
Orgasm 3.80 2.00 5.30 0.68
Satisfaction 5.06 1.06 5.80 0.60
pain 3.90 2.50 4.80 1.04
arousal 2.50 1.70 4.70 1.11
Total 30.60 29.30 76.60 10.10
P lt0.05
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STUDY GROUP
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CONTROL GROUP
PRE POST
Desire 2.40 0.88 3.00 0.80
Lubrication 2.40 2.14 4.70 0.63
Orgasm 2.90 2.32 4.50 0.87
Satisfaction 4.50 2.28 5.50 0.64
pain 3.90 2.50 4.60 0.14
arousal 2.50 1.70 3.50 0.95
Total 26.30 20.60 58.30 26.60
P lt0.05
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CONTROL GROUP
Plt 0.05 for Lubric, Total
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CONCLUSION

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

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THANK YOU, and yohimbine.
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