It has been called “one of the greatest love stories of all time.” MONICA & DAVID is a documentary exploring the union of two adults who fall madly in love, court, get married, and move in together – and who happen to both have Down syndrome. Marked by its humor, hope, romance, and tensions surrounding the need for family support amidst the desire for an independent life together, MONICA AND DAVID captures a couple capable of far more than what adults with Downs are given credit.

With marriage for those with Down syndrome the rare exception to the rule, the film begins the eve before Monica and David’s wedding, with the lovers cooing each other’s pet names - “Winnie the Pooh” and “little baby” – into the phone. It invites viewers to the wedding, with Monica’s sentiments taking on any lack of acceptance and mainstream rejection about the day ahead: “It’s all about him and all about me. This is my day. It’s my life, to be with my husband forever.”

The couple goes on to move in with Monica’s parents, with what it’s like to be a parent of one with an intellectual disability sharing center stage at points. Challenges faced by the newlyweds, like having their routines disrupted and David being diagnosed with diabetes, makes the matter of self-reliance all the harder for all involved. The film follows steps taken by the family to enable the couple to be independent with support.

Directed and produced by Monica’s cousin, Alexandra Codina, the film made its world premiere at the International Documentary Festival Amsterdam, where it won second place for the Audience Award. It went on to win the Best Documentary at last year’s Tribeca Film Festival. In interviews, Codina has described the wedding as “very powerful, very serious, and very adult” – a far cry from the perception others’ have held in it being just a “cute gesture between kids.” Her fly on the wall footage, screened at the 2010 Reykjavík Film Festival, highlights not only the need to change perceptions about the love lives of those with Down Syndrome on a societal level, but the need for their parents to let them become fulfilled in this way as well.

While approximately 200 people attended Monica and David’s wedding, protective parents of some of the couple’s friends, who also have intellectual disabilities, had prevented their adult children from attending, as not to fill their heads with ideas. This difficulty letting go is ironic given the tireless years these dedicated, loving parents have spent advocating for their children to live “normal” lives. Equally difficult is the ability for most people to see people with Down syndrome as sexual beings, longing for romance, companionship, and more.

While the film doesn’t deal with the couple’s sex life, the passion, desires, abilities, affection, companionship, and endless love captured hint at intimacies left to privacy. But its use as a vehicle for societal change needs to involve recognizing that this special population has the same sexual feelings and intimacy needs as the rest of us. Monica, now 38, and David, 32, remind us that people with Down syndrome often have interest in dating, marriage, and becoming parents. Their film, lauded for love without limitation, acts as a wake up call to what people like them want out of life, providing the perfect stepping stone to advocate for the sexuality education and sexual health services.

As with all other human beings, people with Down syndrome have the right to routine reproductive healthcare, emotionally satisfying sexual relationships, and culturally appropriate ways of expressing their sexuality. With 50 percent of women with Downs fertile, and a couple of documented, confirmed cases where males with Downs have fathered a child, it is important to teach them about reproductive health, contraception, sexually transmitted infections, and safer sex in understandable ways. Such developmentally appropriate information needs to take one’s cognitive level and learning style into consideration, and should be enhanced with information about interpersonal relationships, dating, self-esteem, sexual exploitation, avoiding sexual misunderstandings, sexual functioning, decision-making, cultural norms, peer pressure, different forms of sexual expression, sexual values, personal empowerment, sexual responsibility, communication skills, regular gynecological care… Basically, it needs to cover the same topics that should be addressed with everyone in an age-appropriate way. It is also important for healthcare providers and professionals to support parents by initiating structured talks about contraception that provide clear, judgment-free information that’s tailored to the patient’s intellectual abilities.

Thanks to societal changes and medical advances, people with Downs now realize a life expectancy of 60 (versus 25 in 1983), with some living into their seventies. Some are now even going on to college to polish up on social skills, like living in residence halls with non-disabled classmates, in an effort to become more independent and get better jobs. Empowering people with Downs to express their sexual feelings in ways that are socially acceptable and age appropriate needs to be acknowledged, supported and understood. MONICA AND DAVID is slated to be shown on TV stations worldwide.

What sets our sex and sexuality apart from every other animal on the planet is the involvement of our mind and every aspect of our person, not just our bodies.  This means that our sexual activity is much more complex because it exists on many levels - our physical being, our personality, our intellect, our wants and desires, our creativity, and our memories and dreams.  Our capacity for satisfaction, then, also exists on all of these levels, which involves our minds even more than our bodies.  The involvement of our mind and positive mental stimulation leads to a healthy, vibrant, and active sex life with greater stimulation and satisfaction that can endure over time.

Although we are biologically programmed for sex, our mind plays a huge role in directing our sexual activity.  The type of partner we look for, the type of activity that excites us, and how comfortable we feel around our sexual activity all have to do with our mind.  Even our ability to get sexually aroused is, for the most part, controlled by our mind, because we respond positively to those activities, scenarios, and interactions that we already define as 'exciting' or 'sexy', while we turn off to things we find distasteful, rude, or ridiculous.  Knowing ourselves and how our mind works to enhance our sex life can be very useful in creating a sex life that is fun, stimulating, exciting, and continuously interesting.  

The mental part of sex happens long before there is any physical contact.  As we are going through our day, any thoughts we have about sex or sensuality contribute to our mental stimulation for sex.  We may start to plan how we would like our next sexual encounter to be like, or think about the exciting aspects of our last sexual encounter.  By doing this, we are priming our brains to have pleasure with our partner by enhancing the positive aspects in the way we think about our sex life and our sexual activity with them.  We may think of different scenarios that we have had, or those that we would like to try, which increases our interest, motivation, and and level of excitement.

Actually, studies have shown that oftentimes the anticipation of something can be just as pleasurable or more that an activity itself.  The way this works is because our mind gets a great deal of enjoyment from imaging the ideal situation - the most desirable touch, the most exciting surroundings, the most stimulating interactions.  Knowing how to make the most of this mental stimulation helps heighten this pleasure for ourselves, contributing to a more exciting sex life with our partners.  As we explore the mental stimulation aspect of our sexuality, we also learn about our own sexuality and its depth and complexity.

Of course, mental stimulation plays a huge role in the actually moment of sexual contact.  How we think about sex and what we choose to focus on can be the difference between experiencing anxiety, detachment, and disappointment, or experiencing delight, intense excitement, and intense pleasure.  Something as simple as focusing our attention on what physically feels good at the moment, or how our partner is responding or aroused heightens our own arousal and brings us closer to ecstasy.  On the other hand, if we can only focus on getting to orgasm, or are more outside of ourselves with worries and doubts, it cuts into our the flow of sexual arousal and distracts us from our sexual activity.  It is the difference between using our minds to get lost in the moment, and using our mind to take us away from the full experience of sex. 

Want to feel lusty? Go shopping. A recent study at the University of Westminster found that special offers ignite the same level of emotional excitement that one experiences from sexual arousal. Bargains make people deliciously happy, firing up the brain in much the same way as watching an erotic film. 

Researchers measured brain activity in the emotional parts of the minds of 50 volunteers, as well as their eye movements and emotional responses in the body, in determining which of several activities evoked the most excitement. They found that giving participants a coupon or free gift with a loaf of bread or a jar of the savory British spread Marmite induced the same level of excitement as being exposed to porn. 

This makes perfect sense given that the brain emits the neurotransmitter dopamine during positive shopping experiences, which includes special deals. This chemical activates parts of the brain that bring us pleasure. It is also the same neurotransmitter that is released when we fall in love and the one that stimulates the release of testosterone, the hormone of sexual desire. New experiences, like coming across desirable items to purchase and, better yet, acquiring them, triggers this brain chemical of lust, increasing its levels in our system. 

While claims that bargain shopping is as good as sex are certainly debatable, these findings help to explain why people are prone to shopping sprees when down in the dumps. It also gives clues as to how shopping can act as a form of foreplay for some, putting them in the mood for much more sexually stimulating activities when they get home. Whether a past-time, an excuse to get out of the house, a means to feeling less lonely, or a way to kill time, the “shopper’s high” could, arguably, be the occasional quick-fix to a slump in one’s libido. And, in addition to dopamine’s influence on desire, the reason may be wonderfully selfish.

It has long been suspected that people shop when they’re sad or feel badly about themselves, with research finding that we’re more willing to spend when we feel low, depressed, or miserable. Better known as “retail therapy,” this escape from one’s troubles involves people spending more on themselves, even if they don’t have the money. 

As confirmed in a 2008 issue of Psychological Science, a study involving 33 volunteers found that feelings of sadness lead to those of self-centeredness, which ultimately leads to a greater possibility of one spending more money on something that will act as a “pick me up.” The increased degree of self-focus has been suggested as the reason for the over-spending, especially in shopping for things that can make us feel better about ourselves and our look, like clothes.

Instead of devaluing ourselves, we enhance ourselves with more material goods. Spending also fills an inner void in shifting attention from what’s going on inside to making one’s outside more attractive. And that can have any of us feeling terribly sexy.

For years, media headlines have been screaming that everyone is into oral sex. But it’s only recently that we’ve started to see the research results to back this claim. According to a newly published study out of the University of Alberta, oral sex has become quite the common activity for young Canadian women.

Every participant who reported having had sexual intercourse also reported having engaged in oral sex, though interviews with the lead researcher, Brea Malacad, do not clarify if this is oral action is giving, receiving, or both. The research, published in the European Journal of Contraception and Reproductive Health Care, further showed that about half of respondents see oral sex as less intimate than sexual intercourse, though 41 percent find the sex acts equally intimate. What surprised Malacad was the fact that most young women enjoyed oral sex, reporting having mostly positive emotions about the act, with over 30% feeling powerful when performing fellatio.

Whether you’re male or female, going down on a man or woman can invite some of the most intense sexual experiences. For many women, having someone perform cunnilingus on them is their only means or the most effective means to realizing orgasm. This is in large part because the clitoris receives ample attention and can be effectively stimulated quite easily. For many men, having a nice, hot, wet mouth on their genitals, lips tightening around their pride and joy, is an experience like no other. Then there’s the matter of “hero worship” both genders are rather fond of.

For those with disability or chronic illness, oral sex can be an excellent way of staying intimate while getting around a lot of issues that get in the way of other types of sex. If you’re low on energy, have issues with spasticity, lubrication, or erections, or find penetration or thrusting difficult and uncomfortable, oral sex is one way to provide intense pleasures.   

Considered by many to be the most intimate sexual act both physically and emotionally, partners get off on tasting, smelling, and seeing each other in the most up close and personal way. The receiver thrives off of being doted on, while the giver can take great joy in making sure that their lover feels absolutely amazing.

While the prevalence of sexual activity, in general, declines with age, a significant number of men and women still engage in oral sex, amongst other sexual behaviors, even into their eighties and nineties. A 2007 AARP Modern Maturity Sexuality Survey of 1,384 individuals 45 and older found that age itself has the greatest impact on the frequency of oral sex for men and women. Greater physical satisfaction with the relationship was also found to be associated with more frequent oral sex for women. Men and women in shorter relationships were also found to engage in more frequent oral sex than those in long-term relationships.

Such blows away negative stereotypes regarding sexual inactivity in getting older. It further shows that oral is officially a part of many lovers’ sexual repertoires, putting it back in the bedroom as a revered celebration of sexual pleasuring, as it was amongst some of Earth’s earliest people for centuries.  

Though we don’t like to admit it, humans are largely lonely creatures. Whether wasting time on Facebook, searching for a tryst - or more - on a dating website, or hiring an escort for an event or evening, humans are often looking to fill a void. They long to connect and spend time with others. Most recently, this has been seen in the popularity of website Rentafriend, which gets 100,000 unique views per month.

Modeled after wildly successful sites in Japan and other Asian locales, Rentafriend has about 2,000 members who pay $24.95/month or $69.95/year to login and check out other potential friends. ‘Tis a bit sad on so many levels, especially when you consider the ways people overlook the instant connections they make with other people every day.

Take daily “passive contacts,” e.g., nodding to a person at your bus stop every morning. Social psychological research has shown that the more passive contacts you have with an individual, the more likely you are to gravitate toward that person – the likelier you are to connect.

What social scientists call “mere exposure effects” further influence our attraction for others. The more familiar the person, even on a subconscious level, the greater the appeal that individual has for us. So if you’re interested in meeting someone seemingly special or want to make a friend, start by making sure that this person sees you more often, as this alone makes you more attractive and friendly to others.

Once in a person’s space, use touch to your advantage, while being appropriate. As you may recall from a first romantic dinner, we tend to touch and look at those whom we have an immediate liking for, as this communicates closeness and affection (if even the desire for such). Those who touch during a first encounter have reported feeling more affection, trust, relaxation, similarity, and informality. They also feel more immediacy and receptivity with the other in having had the exchange.

These factors lend themselves to feeling closer to and more attracted to the individual touching us. All of this increases the likelihood of making a connection, in part because we’re automatically drawn to the other in picking up that person’s liking for us. Perhaps if people paid more attention to those cues and the people that they’re subconsciously connecting with, they wouldn’t need services like those on Rentafriend.

 

It’s long been suspected that older gals do it better, but more often? Turns out, they’re not getting the credit they deserve, with all indicators being that – single or married, mother or childless – older women are as much about being sexually active as they were in their younger years, if not more. A new study out of the University of Texas at Austin reports that women are more willing to engage in “reproduction expediting” sexual activities, like one-night stands or more “adventurous” bedroom behavior, as their biological clock makes itself known.

The report, published in Personality and Individual Differences, involved more than 827 women, and found that those ages 27 – 45 have a heightened sex drive, which researchers have attributed to their decreasing fertility. Compared to women of high fertility (those ages 18 – 26) and menopausal women, women of low fertility were likelier to report:

• Thoughts about sexual activities and a more active sex life (having sexual intercourse more frequently than women of other age groups)
• Not only more frequent sexual phantasms, but more intense ones than younger gals
• A desire to have casual sex or a one-night stand

Researchers concluded that a psychological adaptation takes place with declining fertility, starting in a female’s late twenties. Women are more willing to engage in a variety of sexual activities, primary of which is sexual intercourse, in an effort to maximize their reproductive capabilities. They admit, however, that other factors could be at play for her increased sexual pursuits, including a woman’s increased comfort with her sexuality with age.

Perhaps they could’ve been more definitive as to their results had they asked the women for their thoughts on the matter beyond simply assessing if they desired a child. Ask almost any woman in her thirties, and there is something about this decade in her life when her maternal instinct kicks into high gear, as 33-year-old pop star Shakira recently told Rolling Stones: “Lately my body feels like it is just asking to reproduce, to have a huge belly and carry babies.” Surprising, disarming, and pleasure-evoking, it’s an energy – a primal stirring – to which many women can relate. Perhaps, too, can her mate(s) – but that’s a whole other study.

It’s down to the last climactic moment. On Saturday, the Netherlands and Spain will play for the 2010 World Cup title, inspiring orgasmic reactions on and off the field alike. While the sex to be had by fans is admirable in celebrating their team’s victory (e.g., there’s a bumper year of births in England the better their team does, which, alas, won’t be so in 2011), football is the love fest. It’s the substitute for sex, capturing hearts, minds, and desires like nothing else worldwide.

Arousing and adrenaline-pumping, it’s the goal scoring in particular that invites an orgasmic experience that can never be had with a lover. The euphoric sensations and feelings players get from scoring a goal – from achieving that lifelong dream - are ones that can never be had in any other way, and shared no more passionately than with one’s teammates.

Best yet, peak performance is with the whole world watching, cheering you on, letting you ride - and ride – this most magnificent climax as your teammates smother you with hugs, kisses, and what, in many ways, looks like simulated sex. For a lot of people, footballers and fans alike, it’s all better than sex.  

The World Cup final match is like no other; it’s more important than any other. Unlike most people’s sex lives, the thrills witnessed here are forever captured in history books. They’re recounted throughout the ages. The fact that both Spain and the Netherlands have never held a World Cup title makes losing their virginity, I mean, celebrating either’s victory all the more “sexciting.”

So who do you predict giving you your kicks this weekend?

There are so many things that make up our sexuality. If I think back over my life, I know that my family's disapproval of certain things, the message that I got from the church, comments from my friends, things I saw on soap operas and movies, and the measly sex ed I got in sixth grade all combined to shape my early idea of what sex was, and what I thought it should and shouldn't be. Luckily, I was a bit of a bookworm, and so I checked out every book I could get my hands on that talked about sex and pregnancy (an alternative route to talking about sexuality). That certainly helped to add to the ideas already formed in my head about sex and sexuality. Even though I think that I was fairly open-minded about sex, loved to talk about it with my friends, and had good first experiences, those things did not prevent me from having some difficulties with sexuality later in life.

Now that I am an MD, psychiatrist, and sex therapist, I can look back to recognize that I had periods of time where my sexuality and sexual desire were affected by such varied things as anger, stress, fatigue, anxiety, self-image, and side-effects from different medications and/or products. Had I not become a psychiatrist, I might not have recognized the different ways these factors were negatively affecting my life and may have not sought to resolve them as I have. Now I don't usually talk about myself personally, but I felt that it was through personal experience and knowledge that I was best suited to comment on how the treatment of women's (and men's) sexual functioning, or dysfunction, is evolving at the hands the medical and the pharmaceutical industry.

Let's get one thing straight. The pharmaceutical industry is interested in making money. By extension, if the medical community can use pharmaceuticals to enhance their patient visits, and therefore income, they will prescribe them. How many medical professionals are hired, and paid very handsomely, each year by the pharmaceutical companies to push their products?

Obviously, advances in medical science have certainly improved our quality of life and life expectancy overall. And this is a welcome advantage of medicine and medications in general. But it seems that, as our society moves more in the direction of instant gratification and desire for quick-fixes, the less people want to take responsibility for their own lives, and the less effort they are willing to put into their lives to make positive, healthy changes. This is a score for the pharmaceutical companies because people continue to be in a condition to ask for, or require, medications. The cycle continues and the more medications they sell.

Now after the great financial success of Viagra, the pharmaceutical and medical industries have been on a campaign to define female sexual dysfunction as a disease or medical condition. In effect, they are discarding all of the personal, interpersonal, emotional, and environmental factors that can negatively impact a woman's sexuality, and instead focusing on the physical symptoms that result in order to label it as "an illness." This is a gross oversimplification and denial of what may really be happening to a woman to cause such a response.

By accepting the disease definition of sexual difficulties, a person is less likely to examine what areas of their life or lifestyle are contributing to their sexual dysfunction, and then work on these. It's easier to just take a pill. After all, your doctor told you that was the thing to do. Funny how nobody talks about the positive response from the placebo effect, which accounts for roughly 30% of response to medications (yes, a sugar pill). That demonstrates that your psychology can trump your biology, but it doesn't sell very many medications.

I love medical science and the practice of medicine, and I do prescribe medications. But I chose to be a sex therapist in order to have a holistic approach to my patients. I have seen the power of the mind to both make us sick and heal us. And when it comes to human sexuality, our mind is the major determining factor in our arousal, our sexual response, and our sexual satisfaction. Recognizing that anxiety and anger account for upwards of 80% of the patients who present with sexual complaints, I am worried about the medicalization of sexual dysfunction. Some have called it disease mongering on the part of the medical and pharmaceutical industry.

I believe that the flip side of that is the denial of responsibility by the patient, because this would suggest some effort and change required of them. Oftentimes, the healthiest thing to do is recognize what is harming you in life and move to change this for the better. Those professionals that have worked in sex therapy with patients understand the role that all of these factors play. They also have first hand experience at helping patients overcome these difficulties, many times without the need for medications and their side effects. I encourage everyone to put medicine in perspective and seek true balance and health, not just a band-aid approach to the complexity of our sexuality.

When it comes to sexual dysfunction, medications can be very efficacious and necessary at times. But this should never overshadow a comprehensive exploration and treatment of all the elements contributing to a person's complaints. Sexual dysfunction is not a disease.


By Madeleine M. Castellanos, MD