A Question of Health: Hard facts about sex

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Is it normal for a fairly fit, healthy man with a strong sex drive to find at 56 years old that his erections have neither the hardness nor the strong pulsations that they once had? The intense pleasurable sensations that used to occur before and during ejaculation rarely achieve their former glory. I look forward to your advice.

Is it normal for a fairly fit, healthy man with a strong sex drive to find at 56 years old that his erections have neither the hardness nor the strong pulsations that they once had? The intense pleasurable sensations that used to occur before and during ejaculation rarely achieve their former glory. I look forward to your advice.

The sad truth is that the body of a 56-year-old human being is not as new as the body of a teenager. The physiology of a strong erection depends on an enormously complex system of blood flow, tissue expansion, hormones and neuro-electrical signals. It is hardly surprising that after more than 50 years of daily use, the machine doesn't work quite as well as it used to. Of course the working parts we are talking about have renewed themselves over the years. But the renewal process is not 100 per cent efficient, and this is the reason why the hardness of your erection has deteriorated. It is possible that Viagra would improve your situation. But no drug is going to hold back the tide of ageing forever. So it is essential to find new ways of finding pleasure in sex that don't depend solely on the hardness of your erection. Your complaint is a common one, but it often goes along with a comment that, despite physical failings, sex gets better with age.

I am getting an increasing number of benign sebaceous oval patches on my stomach and the right side of my chest. There are more than 50 small patches which, my experience tells me, will grow in time. I also have one large one on the lower stomach. I have had a couple of these frozen with liquid nitrogen, but this treatment is hard to come by on the NHS. Aside from liquid-nitrogen treatment, is there an internal treatment to suppress the virus or to give some immunity to the skin? Can I treat myself with various over-the-counter cures such as salicylic acid? The NHS doesn't seem to have much time for these things.

The things that you are describing are known by at least four different names: seborrhoeic warts, senile warts, seborrhoeic keratoses, and basal cell papillomas. They are extremely common over the age of about 50. They usually occur on the trunk. The warts start off as an area of roughened skin, which begins to darken and have a slightly greasy appearance. Occasionally they can be quite ugly. They are benign, which means that they are not cancerous and they never become cancerous. The overstretched NHS tends to have a fairly laid-back attitude to cosmetic skin problems, and this is the reason why you are finding it difficult to find much enthusiasm for removing them. There are two ways to treat them. They can be frozen with liquid nitrogen, or they can be scraped off with the help of some local anaesthetic. The scraping method tends to leave some surface scarring, which fades with time. Unlike true warts that occur on the hands and feet, seborrhoeic warts are not caused by a virus and are not infectious. I am not aware of any dietary changes that will have the slightest effect on the growth of these warts. Salicylic acid might well help to get rid of them, but use it with care and avoid any sensitive areas.

My 17-year-old daughter had a severe allergic reaction to something (a shampoo?) last year, which meant that her face blew up like a football and her skin went hard with white-and-red blotches. It was very frightening, but the problem was resolved with anti-histamine injections from the GP. Since then, however, she has had persistent problems with itchy spots on her neck and forehead and now scabs on her scalp. The medical encyclopedia seems to suggest that she is suffering from cradle cap and eczema – but it says that this is an affliction of babies.

The allergic reaction is worrying, because if it happens again it could be more severe. Unfortunately, it is going to be difficult to identify exactly what she is allergic to. Dermatologists have a range of substances that are used in common skin preparations and cosmetics, and it might be worthwhile having a skin-patch test to see if she has a serious allergy to any of these. If one chemical is identified, she could take care to avoid products that contain it in the future. The itchy spots and scabs sound like a separate problem. I agree with the medical encyclopedia that cradle cap is an affliction of babies. I wonder if she could have developed psoriasis. This is a skin condition that often affects the scalp and hairline.

HAVE YOUR SAY

LW, a pharmacist from Nottingham, follows up my advice on malaria tablets for children:

We travelled to South Africa this summer with two young children (eight and 10) and spent five days in a malarial zone. Malarone is not yet licensed in the UK for malaria prophylaxis in children under 12 (although paediatric Malarone tablets are going to be introduced in the UK soon). The options are very limited for children travelling to "high risk" Africa. Mefloquine (Lariam) is the drug of choice but our 10-year-old developed a reaction to it and we felt sick while taking it. Doxycycline can't be used for children. That leaves the less effective option of proguanil and chloroquine. Despite all this we did have a great time.

Mrs EC from Hatfield in Hertfordshire has found an alternative cure for her migraines:

"I suffered from periodic and migraine headaches for years. A cranial treatment from a chiropractor cured them."

Please send your questions and answers to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax to 020-7005 2182 or e-mail to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions

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