O transtorno do desejo dexual hipoativo e o papel dos canabinoides como alternativa terapêutica: uma revisão bibliográfica
Tipo
TCC
Data de publicação
2022-06
Periódico
Citações (Scopus)
Autores
Zaninetti, Gabriel Augusto
Orientador
Delorenzi, Jan Carlo Morais Oliveira Bertassoni
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
Programa
Resumo
O transtorno do desejo sexual hipoativo é uma disfunção sexual, caracterizada pela ausência ou falta do desejo e da atividade sexual. Estudos apontam para prevalência relevante do Transtorno do Desejo Sexual Hipoativo na sociedade, principalmente em pacientes mulheres. As diversas opções de fármacos disponíveis a base de testosterona não atende de forma eficiente as necessidades de pacientes mulheres com este transtorno, podendo também representar riscos à saúde de pacientes idosos, indicativos da importância de estudos sobre alternativas terapêuticas. O aumento do número de pesquisas e fundamentação da base teórica nas últimas décadas, apontam os benefícios terapêuticos de fármacos à base de Cannabis sativa sp. para uma série de patologias de distúrbios. Sua atividade como anti-inflamatório, anticonvulsivo, antiemético e analgésico é atribuída a produção de substâncias terpenos canabinoides e a interação dessas moléculas com ligantes endógenos (receptores endocanabinoides) localizados no Sistema Nervoso Central e Sistema Nervoso Periférico. Inquéritos de caráter subjetivo apontam para melhoria de múltiplos aspectos das funções sexuais com a exposição regular à Cannabis, sobretudo por mulheres. Os endocanabinoides são reconhecidos por modular comportamentos gratificantes, mas não foi esclarecida sua modulação no comportamento sexual, revelando necessidade no aprofundamento desta relação. Uma revisão bibliográfica foi desenvolvida para identificar as relações estabelecidas dos canabinoides com a modulação do comportamento sexual e as possibilidades de tratamento para TDSH. Foram utilizadas 26 referências sobre ciclo de resposta sexual e TDSH e outras 19 sobre utilização de “Cannabis Medicinal”, para embasamento teórico nos aspectos biológicos e sociais que circundam e relacionam esses temas. Destas publicações, 12 estabeleceram relações entre canabinoides e a função sexual, selecionados 2 artigos para análise e discussão que indicaram possibilidade de ação terapêutica em disfunções sexuais ao analisarem o mecanismo fisiológico de resposta sexual em humanos e sua relação com os canabinoides. Ambos promovem base teórica para realização de futuros estudos, a necessidade de compreender como os efeitos colaterais de outros fármacos afetam o sistema endocanabinoide e apontam diferentes aproximações de tratamentos para pacientes com disfunções sexuais. O primeiro artigo analisado “Concentração dos endocanabinoides circulantes e excitação sexual em mulheres” indicou que as concentrações de endocanabinoide séricos dos grupos analisados diminuiu à medida que a excitação fisiológica e subjetiva aumentaram. Apontou para a necessidade de análise dessas concentrações em grupos de indivíduos com disfunções sexuais como TDSH os quais podem sofrer de desregulação do sistema endocanabinoide e podem se beneficiar de fármacos desenvolvidos com este foco. O segundo artigo analisado “Reatividade individual de prolactina modula resposta do núcleo accumbens (NAc) para estimulação erótica durante intoxicação aguda de Cannabis: um estudo piloto fMRI” revelou que a exposição a elevadas concentrações de Cannabis modula a resposta do NAc direito, apontando para sua capacidade de modular respostas fisiológicas sexuais. Também indicou que a exposição não possui necessariamente um efeito facilitador ou inibidor direto na motivação sexual, evidenciando uma relação direta do efeito estimulante sexual com a direção de resposta da prolactina em cada indivíduo.
The hypoactive sexual desire disorder is a sexual dysfunction, characterized by an absence or lack of sexual desire and activity. Studies point to a relevant prevalence of ADHD in society, especially in female patients. The several options of testosterone-based drugs available do not efficiently meet the needs of female patients with this disorder, and may also pose health risks to elderly patients, indicating the importance of studies on therapeutic alternatives. The increase in the number of researches and theoretical basis in the last decades, point out the therapeutic benefits of drugs based on Cannabis sativa sp. for a number of pathological disorders. Its activity as an anti-inflammatory, anticonvulsant, antiemetic, and analgesic is attributed to the production of alkaloid substances (cannabinoids) and the interaction of these molecules with endogenous ligands (endocannabinoid receptors) located in the Central Nervous System and the Peripheral Nervous System. Subjective surveys point to improvement in multiple aspects of sexual functions with regular exposure to Cannabis, especially by women. Endocannabinoids are recognized to modulate rewarding behaviors, but their modulation of sexual behavior has not been elucidated, revealing a need for further investigation of this relationship. A literature review was developed to identify established relationships of cannabinoids with modulation of sexual behavior and treatment possibilities for HSDD. Twenty-six references on sexual response cycle and HSDD and 19 on the use of "Medicinal Cannabis" were used for theoretical background on biological and social aspects that surround and relate these themes. Of these publications, 12 established relationships between cannabinoids and sexual function, 2 articles were selected for analysis and discussion that indicated the possibility of therapeutic action in sexual dysfunctions by analyzing the physiological mechanism of sexual response in humans and its relationship with cannabinoids. Both provide theoretical basis for further studies, the need to understand how side effects of other drugs affect the endocannabinoid system, and point out different approaches to treatments for patients with sexual dysfunctions. The first article reviewed "Concentration of circulating endocannabinoids and sexual arousal in women" indicated that the serum endocannabinoid concentrations of the groups analyzed decreased as physiological and subjective arousal increased. It pointed to the need for analysis of these concentrations in groups of individuals with sexual dysfunctions such as HSDD who may suffer from dysregulation of the endocannabinoid system and may benefit from drugs developed with this focus. The second article reviewed "Individual prolactin reactivity modulates response of the nucleus accumbens (NAc) to erotic stimulation during acute cannabis intoxication: a pilot fMRI study" revealed that exposure to high concentrations of cannabis modulates the response of the right NAc, pointing to its ability to modulate sexual physiological responses. It also indicated that exposure does not necessarily have a direct facilitating or inhibitory effect on sexual motivation, evidencing a direct relationship of the sexual stimulatory effect to the direction of prolactin response in each individual.
The hypoactive sexual desire disorder is a sexual dysfunction, characterized by an absence or lack of sexual desire and activity. Studies point to a relevant prevalence of ADHD in society, especially in female patients. The several options of testosterone-based drugs available do not efficiently meet the needs of female patients with this disorder, and may also pose health risks to elderly patients, indicating the importance of studies on therapeutic alternatives. The increase in the number of researches and theoretical basis in the last decades, point out the therapeutic benefits of drugs based on Cannabis sativa sp. for a number of pathological disorders. Its activity as an anti-inflammatory, anticonvulsant, antiemetic, and analgesic is attributed to the production of alkaloid substances (cannabinoids) and the interaction of these molecules with endogenous ligands (endocannabinoid receptors) located in the Central Nervous System and the Peripheral Nervous System. Subjective surveys point to improvement in multiple aspects of sexual functions with regular exposure to Cannabis, especially by women. Endocannabinoids are recognized to modulate rewarding behaviors, but their modulation of sexual behavior has not been elucidated, revealing a need for further investigation of this relationship. A literature review was developed to identify established relationships of cannabinoids with modulation of sexual behavior and treatment possibilities for HSDD. Twenty-six references on sexual response cycle and HSDD and 19 on the use of "Medicinal Cannabis" were used for theoretical background on biological and social aspects that surround and relate these themes. Of these publications, 12 established relationships between cannabinoids and sexual function, 2 articles were selected for analysis and discussion that indicated the possibility of therapeutic action in sexual dysfunctions by analyzing the physiological mechanism of sexual response in humans and its relationship with cannabinoids. Both provide theoretical basis for further studies, the need to understand how side effects of other drugs affect the endocannabinoid system, and point out different approaches to treatments for patients with sexual dysfunctions. The first article reviewed "Concentration of circulating endocannabinoids and sexual arousal in women" indicated that the serum endocannabinoid concentrations of the groups analyzed decreased as physiological and subjective arousal increased. It pointed to the need for analysis of these concentrations in groups of individuals with sexual dysfunctions such as HSDD who may suffer from dysregulation of the endocannabinoid system and may benefit from drugs developed with this focus. The second article reviewed "Individual prolactin reactivity modulates response of the nucleus accumbens (NAc) to erotic stimulation during acute cannabis intoxication: a pilot fMRI study" revealed that exposure to high concentrations of cannabis modulates the response of the right NAc, pointing to its ability to modulate sexual physiological responses. It also indicated that exposure does not necessarily have a direct facilitating or inhibitory effect on sexual motivation, evidencing a direct relationship of the sexual stimulatory effect to the direction of prolactin response in each individual.
Descrição
Palavras-chave
transtorno do desejo sexual hipoativo , cannabis sativa sp. , disfunções sexuais , "cannabis medicinal" , sistema endocanabinoide e função sexual , hypoactive sexual desire disorder , sexual dysfunctions , endocannabinoid system and sexual function