Neuropsicofisiologia do desejo sexual: alguns aspectos da regulação funcional da motivação sexual

Abstract

The concept of sexual desire as one of the stages of sexual response in humans began to change in the past decade. Through the advanced contributions of the neurosciences, the neuropsychophysiology of normal functioning of sexual motivation (sexual desire) has been elucidated by the modern methods used in research. The understanding of cultural, social, psychological and biological factors that influence the sexual health can contribute to the promotion, prevention and treatment of the hypoactive sexual desire disorder, the main complaint about sexual health in women and with high prevalence among them. The general objective of this study was to systematize recent neuroscientific data about the desire phase, which could contribute to reflections on new therapeutic approaches by health professionals. And the specific objectives were: 1) to review the scientific literature about the neuropsychophysiological bases of sexual desire; 2) to organize an essay on "the state of the art" of normal functioning of sexual desire; and 3) to favor, from that information, reflections on more effective therapeutic approaches in patients with complaints related to hypoactive sexual desire. The review was carried out using classical literature on the topic and theoretical review of articles published in the last ten years, but it does not constitute a systematic review. The articles comprehended scientific findings based on animal and human model. This review study showed that, with the evolution of knowledge, it has been proposed a new model of non-linear human sexual response, in which the desire phase is best explained by its multidimensional aspects. So far, the major neurochemical systems, related to the normal phase of sexual desire, include pathways involving steroid hormones, dopamine, norepinephrine, melanocortin and oxytocin, which participate in the excitatory mechanisms; and opioids, endocannabinoids and setoronina, involved in the inhibitory mechanisms of the desire phase of sexual response. There is still no consensus on the definition, diagnosis and implications of the hypoactive sexual desire disorder. There are reports of the efficacy of psychotherapeutic treatments, but randomized studies are still lacking. There is still no pharmacological treatment that has been recommended by the Food and Drug Administration (FDA) for women. There are only some available for men. The updating of knowledge by health professionals, regarding the new proposed model for the sexual response cycle and the neurochemistry of desire contributes to a new approach to the patient.