Chinese men have long used traditional medicines such as deer antler, caterpillar fungus, and wolfberry to treat impotence. In recent years, Pfizer has found success touting a different remedy: better sex via its little blue pill. Men on the mainland are listening, sparking a 47 percent surge in Viagra sales in the country in 2014, says Pfizer citing data from IMS Health. That’s helped to offset the 24 percent drop in total international revenue for the drug last year.

Shifting cultural trends brought on by China’s decade-long economic boom have fueled demand, and Pfizer’s extensive patient-education campaign about ED has kept users loyal even as Viagra lost its patent protection last year and cheaper competitors have emerged. As China has loosened restrictions on discussing sexual health, people have paid more attention to that aspect of their lives, says Ma Xiaonian, a clinical sexologist and deputy director of the China Sexology Association. “When one is warm and well fed, one will think about lust,” says Ma, quoting an ancient Chinese saying.

Pfizer’s revenue from its mature drugs in China rose 18 percent last year, a much-needed boost for the company. Pfizer in January forecast its fifth straight annual decline in global sales, due largely to patent expirations for big drugs including Viagra and cholesterol fighter Lipitor.

Since 2013, Pfizer has begun numerous erectile dysfunction education campaigns in China to raise awareness of the need for ED medicines. Last year it sponsored a survey about the sexual health of more than 10,000 Chinese professionals, and the results were distributed in a publication called the China Ideal Sex Bluebook. The report, sprinkled with references and images of Viagra, provided advice and chronicled sexual trends.
Pfizer also sponsored a smartphone application that provides daily factoids and suggestions on male health and performance. On April 1 the entry advised readers to keep cell phones at bay during sex. Pfizer estimates that in 2014 its educational efforts resulted in 9 billion media impressions in China.

Such promotions would have been unthinkable a few decades ago, when discussing sexual matters was rare or even considered “spiritual pollution.” But Ma says that economic growth has brought lifestyle changes among Chinese men that are likely prompting the demand for sex drugs. Those changes and the lack of an exercise culture have led to a spike in the incidence of obesity, hypertension, diabetes, and other diseases that can interfere with sexual performance, he says. Chinese nowadays “sit more, move less, exercise less, and have more bad habits. And all these affect sexual abilities,” Ma says.

Pfizer puts the prevalence of erectile dysfunction among Chinese men from 30 to 60 years of age at about 28 percent, citing a large-scale epidemiological survey. That suggests the potential urban patient population for the drug could be about 68 million in China, where Viagra commands more than 60 percent of the ED market, Pfizer says. That’s made China a safe haven for Viagra, even though Eli Lilly’s Cialis surpassed it in worldwide sales in 2013.

Still, competition is intensifying. A generic erectile dysfunction drug was introduced by Guangzhou Baiyunshan Pharmaceutical Holdings in October. Baiyunshan, whose generic is called Golden Dagger-Ax, priced its product up to 60 percent cheaper than the 130 yuan ($21) per pill that Viagra goes for at one online pharmacy in China. Baiyunshan is also trying to boost demand by conducting its own education programs for patients and physicians, according to Zhu Shaoxuan, manager at the company’s factory in Guangzhou. Analysts say, however, that Viagra has been able to maintain its big lead in China without cutting prices because many consumers have more confidence in foreign drugs.