Are problems with sex inevitable as men age?

Q FOR the past 15 years or so, I’ve not been able to get the erections I used to. Is this simply an age thing? I am 68, but lean and very fit. I exercise regularly (sit ups, weights, etc), play a lot of badminton and I eat extremely well.

David Brennan, by email.

A A DECLINE in erectile function is a very common problem — studies show it affects half of all men between the ages of 40 and 70 to varying degrees, but men are often too embarrassed to seek help, so there will be many readers grateful for your letter. erectile problems can have a number of causes but, by far, the most common is an issue with vascular function.

To achieve and sustain an erection you need an increase in blood flow into the penis.

Central to this is a chemical messenger called nitric oxide, which relaxes the muscles that control the blood vessels of the penis, allowing them to stretch and fill with blood. But certain things can disrupt the release of nitric oxide — including smoking, diabetes and a deficiency of the male hormone testosterone that can occur with age.

Diabetes can harm sexual response in another way, as it’s associated with raised levels of cholesterol that can clog up the tiny blood vessels in the penis.

High blood pressure can have a similar effect, reducing blood flow. This is why erectile dysfunction is now regarded as a marker for coronary artery disease.

You clearly have a healthy lifestyle, but I would still recommend seeing a doctor who can arrange blood tests to look for signs of diabetes and low testosterone (testosterone levels decline with age, but that decline is accelerated in men with type 2 diabetes — a third of men with type 2 have low testosterone).

You may also need an ultrasound scan to look at the blood flow in the vessels that supply the penis to see if narrowed arteries are to blame.

You mention in your longer letter that you’re worried that eating anti-inflammatory foods might be the cause: in fact, I know of no data confirming that there are any food or drink choices, apart from alcohol, that lead to erectile failure.

Q LAST year, I had a leaking heart valve replaced and am thinking of buying a vibration plate. I am 82 — would it be a safe way to exercise?

Mrs M. Donegan, Tunbridge Wells, Kent.

A IN MY view, it’s safe for you to use a vibration plate, but I do have a caveat.

First, however, for the benefit of other readers, let me explain that a vibration plate is a piece of kit you stand, sit or lean on as it vibrates vigorously. The theory is that this stimulates your muscles.

The big question is, will it do you any good?

The idea is the vibrating platform transmits energy through the body which forces muscles to contract, as if you are exercising. There are claims that using one for just 15 minutes daily aids weight loss, and has a number of beneficial effects on metabolism, such as fat burning and reducing levels of the hormone cortisol, so it’s also a stress buster.

However, there is no high-quality independent research to confirm these claims. Contrast that with cardiac rehabilitation, a supervised

exercise programme available on the NHS, where you’re given an exercise programme, dietary advice and support, and where there is clear evidence to show that this can reduce the risk of premature death in patients with coronary heart disease.

It also undoubtedly improves longterm outcomes for patients who, like you, have had heart valve surgery.

my worry is that, while a vibration plate might potentially provide a degree of improvement in fitness, it also provides an excuse to refrain from what we already know is the best activity available — regular physical exercise in some shape or form, as long as there are no other health problems (such as severe hip or knee arthritis) that might prevent you from doing it.