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While your brain is the primary influence on the quality of your sex, sometimes our machines break down, sometimes our parts don’t work, and sometimes the sex organs do not function properly. That kind of problem does require some fixing, but I’d also argue that oftentimes we’re looking in the wrong place.

If your car has a flat tire, you inspect the tire, look for the nail, remove the nail, plug the puncture hole, and you’re on your merry way. If you sexually (and obviously metaphorically) have a flat tire, the first place you should inspect isn’t your actual tire.

Yes, we can treat sexual dysfunction with meds, lubes, and pumps; some cases require those kinds of fixes. But when it comes to sexual dysfunction, we need to spend more time looking under the hood. That’s because the No. 1 cause of that is bad blood flow due to inflammation. The major factors that determine whether a sexually active couple at age 50 will still be having sex at age 85 (and beyond) are that both partners are still alive and together and the level of inflammation the man has in his system at age 58, according to a study called the National Social Life, Health, and Aging Project.

While hormones and other chemical processes influence your desire to have sex, your ability to have quality sex is dictated by: how well blood moves through your arteries to your penis or vagina. For men to have an erection, blood needs to flow freely through the arteries into the penis; the blood is subsequently trapped there in order to maintain the erection. For women, proper blood flow is important to help stimulate nerve endings and lubrication, important factors in pleasure and orgasm.

Among the reasons our parts don’t work correctly is blood getting diverted or slowed down along the circulatory transit system. That could be caused by conditions such as diabetes, high, lousy LDL cholesterol, and high blood pressure, all of which screw up the in-and-out flow of blood through the body. Now, a gas you put out is key here. Nitric oxide is made by the endothelial cells lining your arteries. The release of this gas is prolonged by erectile dysfunction drugs like Viagra and Cialis. Nitric oxide gas dilates your arteries, and you produce two types: an “always there” source that causes fast dilation and, in the context of exercise, enables you to run fast without much of a warm-up. Then there is the kind that lets you run longer and harder after your warm-up. In fact, as we get older, we need to warm up longer on the track and in bed, as our always-there nitric oxide fades, leaving just the nitric oxide we must activate with our own warm-up.

This may sound like the least sexy of suggestions, but if you want to have better sex, eat vegetables. If you want to have better sex, walk 10,000 steps a day. If you want better sex, you need to manage your responses to stressors. If you want better sex, eat more healthy fats. If you want better sex, do what’s good for your entire cardiovascular system.

Dr. Michael F. Roizen is chief wellness officer and chair of the Wellness Institute at Cleveland Clinic. Follow him on Twitter @YoungDrMike.

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