The Kenya Association of Urological Surgeons (KAUS) ranks performance anxiety, a purely psychological problem, at 10 per cent of impotence cases. Other underlying factors associated with inability to rise to the occasion are advanced age and disorders such as cardiovascular diseases, and diabetes mellitus. Defined as the inability of a man to achieve and maintain an erection sufficient for satisfactory sexual activity, erectile dysfunction is estimated to affect over 200 million men worldwide.
Magical white ginger plant?
Since ancient times, plants have provided dependable remedies for different ailments. Even without proper scientific scrutiny on mechanisms of action, side effects and contraindications, the very famous “mukombero” – white’s ginger plant – has been sold in the streets as a sure way to rise where it matters most. Cheaper compared to other pharmaceuticals, quite a number of men testify that mukombero allows them to go the extra mile in the bedroom. There are even concerns that its demand may drive the plant into extinction. A 2019 study by Kenyan researchers, focusing on the effects of the plant on serum testosterone levels in male albino rats, found insignificant effects after 30 days of treatment. Whether mukombero is an elusive dream or imminent reality, traditional medicines for sexual performance enhancement need further examination on formulation for regularisation to ensure safety and effectiveness.
Viagra; the tiny blue pill with “big” outcomes is one of the most popular drugs among men where matters sexual performance enhancement are concerned. It is medically known as sildenafil citrate. The drug was initially synthesised for treatment of blood circulation disorders. In the late 1990s, the drug was approved for the treatment of erectile dysfunction in the US. Viagra penetrated the market quite fast with over 30 million men worldwide buying it within the first two decades of its approval. The Pharmacy and Poisons Board has registered at least 11 sex enhancement drugs for use in Kenya. Viagra and Cialis are the most popular. Vardenafil, also known as Staxyn or Levitra vivanza, is also used. KAUS warns that one should only take sexual enhancement products through a prescription acquired after a detailed discussion of medical history, the risks and benefits of using the drug. This means that buying Viagra over the counter is illegal.
Mechanism of action
After oral administration, Viagra is easily absorbed in the small intestines with peak concentration between 30 to 120 minutes. The National Institute of Health reports peak efficacy of just 19 minutes when the drug is administered on an empty stomach. It is important to note that its absorption is reduced when taken with a high-fat diet. Interestingly, duration of action can last as long as 18 hours! When ingested, there is increased blood flow to the genital area. The drug unblocks blood flow which enables swelling of penile tissue. It sort of “fixes plumbing problems”. Associated side effects include headache and flushing; these are normally short term and easily managed.
How effective are they?
A study conducted by Prof George Magoha in 2000 reported that 91.32 per cent of men with erectile dysfunction showed improved sexual function after therapy with Viagra. The study titled “Sildenafil (Viagra) in the management of male erectile dysfunction in Nairobi” reports that a majority of men who gave positive reviews of Viagra treatment used 50mg of the drug. The study concluded that even with a peak ED incidence in men aged 60-69, Viagra is a well-tolerated option for treatment of the condition. The improvement included revamped erectile and orgasmic abilities and overall sexual satisfaction.
Who shouldn’t use Viagra?
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Conditions contraindicated with Viagra include:
· Peyronie’s disease. This is where scar tissue inside the penis makes it appear curved. It can lead to painful erections.
· Liver problems
· Heart attack
· Blood circulation problems
· Renal impairment.
Women whose male partners have a higher sex drive may become quite overwhelmed in trying to keep up. Addyi, a drug that came with strong warnings of adverse effects like fainting and low blood pressure, was approved by the US Food and Drug Administration in 2015 for use by pre-menopausal women. Experts however doubt that the drug will be equivalent to how effective Viagra is in men. Most healthy women can have their libido rolling when they have no relationship troubles and are in the right frame of mind.
Alternative options for sexual performance enhancement.
1. Penile injections to produce erections
Self-administered injections of prostaglandin E1 provide a simple means of obtaining a natural erection. The prostaglandin E1 relaxes the smooth muscle prompting opening of blood vessels. The patient is trained on how to administer the injections and told what to do in the event of problems such as an erection that will not go down.
2. Medicated urethral system for erection (MUSE)
Insertion of a prostaglandin pellet into the urethra is no longer widely used because of its poor success rates and significant side-effects.
3. Vacuum erection assistance devices (VEDs)
VEDs provide a simple way of obtaining an erection for 30-45 minutes by sucking blood into the penis and holding it in place with a constriction. Ejaculation may be restricted by the ring but this technique is simple, safe and has no known side-effects. Unfortunately, most patients have to purchase VEDs themselves because it isn’t covered by insurance.
4. Vascular surgery/angioplasty
If you have blockage of the large blood vessels to the legs and the pelvis, it may be possible to undergo reconstruction of the arteries or angioplasty to re-establish erections. Re-vascularisation for small artery blockage is rarely successful.
5. Penile prostheses
Insertion of artificial penile implants is highly effective. It is reserved as a last resort when all other forms of treatment have failed. It involves major surgery with a significant risk of complications. You will need to undergo long-term follow-up in a specialist andrology unit for many years after the surgery.