Ten years on after the introduction of Viagra to Egypt, Gamal Nkrumah examines the so-called wonder drug's implications Hag Ahmed's predicament is the mirror image of Hassan's, even though there is a considerable age difference between the two: Hag Ahmed is 68 and Hassan is 28. Hag Ahmed follows the tenets of using Viagra to the letter. He consults regularly with his general practitioner and the pharmacists he deals with. He even presents his special friends on certain occasions with a box of Viagra. "My friends appreciate it far more than a tie or expensive cufflinks," he chuckles. Listen to a pharmacist selling the drug in full-on lobbying mode and it might bring a tear to your eye. Hag Ahmed reminisced about his passionate love for his wife when they first got married. "Everything changes. She no longer arouses me," he laments. In hushed tones, he confesses to having marital problems due in large measure to his impotency and her obesity. He glanced sideways as he recounted his exigency. Hassan, on the other hand, is a newly-wed whose first night with his beloved was a disaster, leaving them both disconcerted and disconsolate. For him, Viagra was the perfect instrument to overcome his nervousness and make it up to his young bride. Viagra and its equally potent equivalents have become all the craze among Egyptian men. There are generally two concepts of Viagra usage in Egypt: those that cannot do without it and those who are looking for extra fun by using it. Erectile dysfunction among older men appears to be primarily caused by physical or health limitations. Indeed, this particular prickly problem seems to impact older men more often. There is no doubt, experts agree, that as a general rule of thumb, older men do face more serious consequences if they abuse the use of Viagra without proper medical consultations. However, "there are perfectly healthy young men that want to experiment with Viagra to enhance their sexual abilities," said pharmacist Manal El-Shazli. "Pornographic films have become readily available on satellite television channels and the Internet. An ever-increasing number of young men want to try everything they watch and they believe that Viagra is their best friend; that it is the ideal instrument to realise their dreams." Nonetheless, any obsessive reliance on Viagra might end up in disaster. Both the old and the young could pay dearly -- sometimes with their lives -- for the misuse of Viagra. Twenty-one-year-old Mustafa tried it on a bet with his friends and was rushed to hospital. Among the side effects that indicate an adverse reaction to Viagra include palpitations, dyspepsia, headaches and flushing. Most medical practitioners advise that the use of the drug should be stopped immediately if any of these symptoms occur. While most men in their 20s and 30s do not have the pressing need to use drugs that alleviate the embarrassment of erectile dysfunction, for many diverse reasons, younger men seem to periodically go through the motions of resorting to Viagra and other similar drugs, albeit for shorter periods. Younger men seem to suffer from psychological quandaries when it comes to impotency and many associate Viagra with fun. "Perhaps it didn't work out well, or at all, on the wedding night. The day after, he is doubly insecure about his sexual prowess, even though this is a fairly common occurrence," explained El-Shazli. "Young grooms who find themselves in such situations jump to the conclusion that Viagra is the answer. And, to tell you the honest truth, it often helps to break the psychological barrier of anxiety and lack of confidence." Her sanguine view of the subject is reassuring. "The most critical factor in the use of Viagra and other generic drugs designed to enhance sexual performance among men, is determining the right dosage. An overdose could lead to fatalities," Khaled Abu Adhma, a medical doctor, told Al-Ahram Weekly. "Viagra lowers blood pressure, but this does not mean that it is safe for all hypertensive patients. It is extremely dangerous for diabetics, for example, to use Viagra or any other similar drugs. That is because blood pressure and sugar levels in the blood fluctuate in a diabetic. Ultimately, the user of Viagra must pay the utmost attention to the dose -- that is key to the well-being of the user," Abu Adhma said. "The most common starting dosage is 25 milligrammes. There are young men, however, who can tolerate as much as 120 milligrammes. To put it crudely, these are healthy youngsters who want to make the most of a dirty weekend, for example. I would not advise an older man to indulge in such an activity even if he is in reasonable good health." Originally developed by Pfizer, Viagra, or sildenafil citrate, is also sold under the commercial name Revatio, which is curiously used as a curative remedy for certain types of hypertension -- especially pulmonary arterial hypertension. "There is a misconception that Viagra is dangerous for people suffering from hypertension. That is not always the case. Indeed, it can be fatal for people suffering from hypotension, or low blood pressure," El-Shazli explains. Patients of ischaemic cardiovascular disease and angina pectoris are especially at risk. Hypertension is a potential killer when Viagra is not used in moderation, even though the drug is used to alleviate the symptoms and ease the suffering of those who suffer from pulmonary arterial hypertension, a relatively rare disease. On the other hand, individuals who suffer from hypotension are not advised to use Viagra. Men suffering from severe hepatic impairment and liver malfunction are also not advised to use Viagra and its replacements. It goes without saying that those suffering from cardiovascular disease risk their lives when they gobble down even a small dose of Viagra. The perennial question remains: when to use the drug and in what dosage. Fatal overdoses are not unheard of in Egypt, whether among the old or the young. El-Shazli points out that, from her personal experience, those who purchase Viagra and other drugs designed to combat erectile dysfunction invariably consult first with their general practitioners. "They are aware of the recommended doses for their age and health condition. They do not purchase these drugs haphazardly and are usually keenly aware of the consequences of not consulting with a physician," she adds. Long gone are the days when shock and awe were associated with the wonder drug that can give perfectly an ordinary man the illusion that he is a stud of sorts. A decade after the introduction of Viagra, the excitement still lasts and it is as ticklish a subject as ever. Some men diligently take the drug, others try to do without. The danger lies in trying it, after which most men get hooked. Television advertisements of Viagra and other replacement drugs such as Vardenafil (Levitra) and Tadalafil (Cialis), as well as cheaper generic drugs, abound. "Mechanics, taxi-drivers and plumbers go for the LE5 generics. Professionals and businessmen go for the more expensive brands," El-Shazli notes. "There are now Syrian, Indian and Egyptian generics on the market that are by far cheaper than the Western pharmaceutical multinational originals." This profusion of uncontrolled Viagra substitutes suggests that El-Shazli's assurances that most users are under doctor's supervision are somewhat callow. Given that the incentives and desire for sexual gratification are so great, the usage of Viagra is bound to intensify. While the drug and its competitors have saved marriages and ruined others, the magnitude of the physiological and psychological changes they induce are impossible to dismiss. Yet, the question remains whether these changes can be similarly induced by traditional herbal remedies that can be considered substitutes for Viagra. Aphrodisiacs (herbal Viagra) have become popular in Egypt. Many soups that are regarded as aphrodisiac are consumed locally, including the Alexandrian and Port Saidi versions of molokhiya, cooked with prawns and shrimps, and rocket and water cress, which are regarded as particularly potent aphrodisiacs. "Time past can never be regained," Proust once mused. It seems that many Egyptian men have repudiated his philosophy. For them, there is now plenty of time to catch up on what they think they have missed out on.
