"It never hurts to get some help." This was a statement made by 22-year-old Paul Kimani who had just admitted to having used Viagra. The ladies were silent as if not sure they heard him right. How could this young, athletic man ever need help? The men were busy throwing jibes at him, "Are you insane?" "That is medication for the old!" As Paul tried to defend himself, a mission that failed, I could not help but think that perhaps he did not know what exactly the use of Viagra was.

This was a deficit which later became evident among the general population as I set out to investigate whether people are aware of Viagra and its function and what their general perception is. Some 80 per cent had heard of Viagra but when asked to explain its function people started fumbling. "It makes you perform for a longer time," Ben an IT specialist said. Mary, a college student on the other hand said, "It makes the phallus larger and as such a woman can get more pleasure."

Most people, however, described it as the pill taken to aid in sexual arousal but failed to capture the essence of it as a medication prescribed to treat erectile dysfunction. First key point, Viagra does not raise the man's libido as was the allusion. Libido is the desire for sexual activity. Erectile dysfunction, on the other hand, is when a man is unable to achieve or sustain an erection adequate for sexual intercourse.

Among younger men, ED is often caused by anxiety that involves the thought of just having sex, anxiety to please their partner or fear of getting her pregnant. Amongst the middle age, overworking, work or family stress and physical tiredness time and again feature prominently. In the old, physical causes become more common and this is termed as a true clinical impotence.

True clinical impotence is a harbinger of pathologies associated with nerves or blood vessels caused by diabetes that is coincidentally a very common disease in Kenya. Impotence may also be an indication of cardiovascular illness like hypertension. Other common conditions that may predispose to ED include: prostate cancer, brain tumour known as prolactinoma, pelvic surgery or trauma, heavy smoking and as side-effects of some medications.

To address the challenges that come with ED many societies have used aphrodisiac which are basically substances or activities which are supposed to heighten sexual interest and desire. Different cultures throughout history have used diverse substances as aphrodisiacs. For example some cultures have built up their own aphrodisiac rituals such as dances whose purpose is to highlight female beauty arousing the audience, others have used foods like garlic whereas some have used tiger penis and rhinocerous horn believing that these animals are virile and strong and so people want to get those qualities out of them by using their products!

Kenya is not an exception. So foreign was the concept of using an ED drug that it would not be uttered out in public. But times have changed and people have come to accept erectile dysfunction is indeed a problem that luckily has a treatment. However, some people still consider it a taboo subject as evidenced by an elderly lady who told me not to bother asking for her opinion and to get away from her, "Wewe unatuletea sisi wanawake waafrika aibu kwa kuuliza maswali kama hayo." (You are embarrassing the African woman by asking such questions).

Unfortunately, this is the opinion of some people and we cannot judge them.It could be due to upbringing, where during those times such matters were not discussed but also due to lack of general education in some areas, more so the rural areas. Hence there is a need for general education and majority felt there is a need to emphasis on dosage and side effects, which would be in order to avoid accidental abuse.

At first it appeared to be common knowledge that Viagra is meant for use by the elderly who have erectile dysfunction with 52 per cent saying it is men above 55 years who use them. It therefore came as a surprise when Simiyu, a pharmacist in the CBD disclosed to me that young people between the ages of 20-30 would come and purchase Viagra. "I get boys barely out of their teen years boldly requesting to buy Viagra." This raised another important question of how did these young people purchase it, yet it is a prescription drug.

Were people even aware that Viagra is a prescription drug? 58 per cent were aware but even more shocking was the fact that 22 per cent thought the prescription should be eliminated. But it being sold as an over the counter drug should not even be a consideration. Viagra which is actually a trade name for Sildenafil citrate was initially used for the treatment of pulmonary arterial hypertension (PAH) and its role in erectile dysfunction treatment was stumbled upon.

Sildenafil acts by inhibiting cGMP-specific phosphodiesterase type 5, an enzyme that promotes degradation of cGMP which regulates blood flow to the penis and eventually leads to an erection. For treatment of pulmonary arterial hypertension (PAH), sildenafil has been renamed Revatio and is a white, round, film-coated tablet. Viagra on the other hand is blue and diamond shaped. It has also proved helpful in altitude sickness and it is not just an erectile dysfunction drug as was the general perception.

Viagra's popularity with the youth for recreational use is increasing at an alarming rate. Some young adults think that it increases libido, improves sexual performance or permanently increases penis size. This is misguided as when used by those not suffering from erectile dysfunction it has little effect.

Dr Moses Obimbo, a consultant at University of Nairobi, School of Medicine cautions that the rush to embrace Viagra amongst men especially the young, without due and proper medical consultations may obscure serious underlying medical problems for which impotence heralds. "Thorough review of patients to rule out any organic causes of ED should be undertaken and if found handled as appropriately before prescribing any erection enhancing drugs," Dr Obimbo adds.

The prices of erectile dysfunction drugs also come into play. An original Viagra tablet of 100mg is locally sold at prices ranging between Sh900-1200. The generic brands, however, are far much cheaper with brands such as Camara ranging between Sh90-150 and Vega Sh50-100. "Most locals opt for the generic as compared to the original and if they do buy the original it's one or two tablets," a local chemist said. He later went on to add that even females do come to buy the pill for their partners though it's usually older females. "I gladly go to the pharmacy and buy Viagra for my husband. In this day and age it's nothing to be ashamed of," Elizabeth, a 39-year-old news editor admitted to me.

Viagra is available in all level 5 pharmacies, that is, those in provisional and higher district level hospitals, in many local chemists and it could also be ordered online. It was the opinion of 90 per cent of the respondents that the prices of the original drug should be subsidised. Apparently, some felt it was one of the ways that sub-standard products were dumped on developing countries. This reason is misplaced as generic brands are not less effective.

A more appropriate reason for support of reduction of prices was affordability to the common man. This perhaps could be the reason why a 52-year-old security guard insisted on referring to Viagra as Vega which are two different brand names for Sildenafil. But since Vega is more available to him, he associates any ED drug under the label Vega.

It was interesting to note that not many people would openly admit to using Viagra, this was 88 per cent of those questioned. Most felt it is too personal an issue while others like Tom Otieno felt it is a sign of weakness, "African men do not require any assistance in pleasing their women." But the main factor which came out though not uttered, people were afraid of other people's opinions. One would hear the research was on Viagra and first hesitate. Women were more reserved on the issue, probably because Viagra is meant for men, a fact which some people were not aware of.

The specific usage is due to anatomical factors, as it is a man who has a phallus and can therefore achieve an erection or lack one, hence erectile dysfunction. In addition, trials of Viagra in women have had disappointing results. As much as the drug increased tumescence of tissue around the vagina just as it had in the phallus, it did little to increase women's sexual desire or enjoyment. But it is still an issue that relates to women and they need to be more enlightened. However, most men did not feel that it was proper for a woman to suggest to her partner to visit the doctor in order to get a Viagra prescription. "A woman would be out of line in suggesting such a thing to me," replied Joshua, a 29-year-old Matatu driver.

Amazingly, 76 per cent thought that men who use Viagra could be characterised. Most felt it was a western world practice and we had our own aphrodisiacs to deal with that. Some female respondents thought it was short and fat men who got ED. This is probably due to myths associated with penile size and its relation to height and weight.

A few felt it was for the rich as they were aware or had suspicions that the original Viagra tablet was expensive. As 24-year-old Patrick, a resident of Kayole put it, "Kama ingekuwa affordable tungeweza buy mtaani lakini haipatikani. Hivyo ndivyo ninajua ni dawa ya wadosi." (If it was affordable it would be readily available in the estates. But since it's not it must be a drug for the rich.) The young man went on to state that due to the price, he and his friends usually use vitality drinks such as Enzoy as a substitute.

The Enzoy sachet is found at prices ranging between Sh50-80. However, the concept of the vitality drink being on the same platform as Viagra is misled. A vitality drink only serves the function of increasing your libido but does not deal with erectile dysfunction. In addition, it does not require a prescription.

Many doctors and urologists are buoyant about Viagra as a drug but warn that the drug is relatively new and nobody actually knows of its long term effects. Scientific data, however, shows that the drug is well tolerated with mild side effects that range from headache, dyspepsia, flushing, abnormal vision, dizziness, nasal congestion and rash.

General education about Viagra and other erectile dysfunction drugs is needed. This will prevent misguided perceptions, assumptions and misuse. Erectile dysfunction is a condition that affects men without discrimination of race, ethnicity, height or weight. The treatment is equally not recommended for just a specific culture or group of people.

Therefore, men should not feel ashamed to share with their partners if they need to use Viagra for it's a normal condition, that most men are bound to develop with age. Women, in that respect, should not look down upon such men as frail or as lesser men. Instead, they should stand by their partners to avoid adding psychological trauma to physical stress. As much as people are entitled to their own opinions, the fact remains that Viagra is a medication, a prescribed medication at that. It is not to be taken recreationally. It is more than just a blue pill.