Dying to perform

Recently, a man died in a bedroom act in Dandora, Nairobi. The police found an assortment of drugs in the house which the deceased had allegedly taken.

Then, a man from Migori County died after allegedly taking sexual enhancement drugs. According to a police statement, the man had booked a room but after taking the pills, his partner changed her mind.

Around the same time, a businessman based in Mtwapa died in the act after developing chest pains. Again, it was said the blue pill was at play.

The romour mill is rife too with men of high standings who have perished because of the use of the blue pill. The streets are also awash with numerous stories of young and old men alike who have succumbed to the use of sexual enhancing drugs.

Alarmed by the increasing incidences the Pharmaceutical Society of Kenya issued a statement last month warning the public against the indiscriminate use of sexual performance drugs.

"We caution the public to refrain from accessing the medicines without a full evaluation, diagnosis, and prescription by a qualified medical practitioner," read the statement from Dr. Louis Machogu, the chair of the organisation.

The doctor urged those with prescriptions to access the drugs from only registered pharmacies and those verifiable through the 21031 SMS code.

Access issues

Indiscriminate use, easy access, and misuse of sexual enhancing drugs are cited as among the causes of the spike of men dying under the blue pill.

Investigations by the Saturday Magazine reveal that sexual enhancement drugs are some of the most commonly purchased drugs in local pharmacies. They are cheap and readily available over the counter. Generic blue pills cost as low as Sh50 per 50mg tablet. A 2019 report by Pfizer which manufactures Sildenafil Citrate popularly known as Viagra showed that the blue pill is the most purchased drug in Kenya's e-pharmacies.

Case of young men

Contrary to belief, the majority of users are young men and not senior citizens with low libido or with erectile dysfunction. So why are young and energetic men dying to perform?

"We don't use Viagra because we are unable to achieve an erection. We do it because we want to impress our girlfriends," says Carlos Ndambuki, who works as an insurance agent in Nairobi. Carlos, 32, says that nowadays, men are judged by how long they last in bed.

"Quantity has replaced quality. Sex longevity is now a major deal-breaker in relationships. Women don't want the one-minute man. If you don't perform, you will find your lovers mocking you on Kilimani Mums and online Girls Chats, or your one-minute video circulating on Telegram," Carlos says.

He has used the blue pill to make an impression in bed. "I once had sex with a woman and failed miserably due to what I came to understand was the anxiety of the first time experience. I felt so inadequate and I could tell the lady was not impressed too, even though she didn't say it," he says.

In their next sexual encounter, Carlos was afraid of failing again and decided to try the blue pill. "I had heard that it could make you last for hours. I wanted to test it and prove that I was a man. I bought one pill at Sh50 and broke it into pieces. I swallowed one piece. I was afraid that I could suffer a heart attack if I popped the whole tablet. The piece I swallowed worked well and I redeemed my self-esteem before the girl's eyes," he says.

Sexual perceptions

Unrealistic perceptions about sexual performance and addiction to pornography are the other reasons pushing men to use sex-enhancement drugs. Pornography actors make most men feel inadequate, both in skill and size, and longevity. This is compounded by women who watch porn and expect the same level of skill and longevity.

Moreover, in the era of sexual liberation, bedroom matters are no longer issues discussed under the covers. Now, there are social media groups or vloggers out there, dishing out sexual information by the bucketful. This pressure, as Lincoln Tiamasi found out spells disaster for unions.

The 29-year-old was dumped for failing to last in bed. "She had never been with someone who lasted so short, she told me. She justified the breakup by saying that she'd rather we parted ways than cheat on me," he says. Over the last three years since that breakup, Tiamasi has used sexual enhancement drugs every time he gets intimate. "The blue pill is my source of pride, prestige, and self-esteem," he says.

This is echoed by Clinical Officer Stephen Okello who has previously experimented with performance-enhancing drugs. He says that the pill is not all doom and gloom. "I feel that the pill has helped many men to secure their relationships. The problem is that the side effects are tough to absorb," he says. Mr. Okello says that most men have resulted to using erection drugs because it has erased the embarrassment and stigma of admitting to a doctor that they are suffering from erectile dysfunction (ED) or are unable to last longer in bed. "No man wants to admit even in privacy that they are not able to get an erection or have longevity," he says.

Side dishes

Incidentally, among married men, the drugs are not taken to impress their wives but to impress their side dish. This might explain why the majority of the recently recorded deaths are of married men or men in already existing long-term relationships. None of the deceased victims died while with their rightful partner.

One of the men died three months ago in Kiminini, Trans Nzoia after overdosing on Viagra in what police said was his mistress's house. But despite the rise in deaths, many men are not about to stop taking the pill. "I can't stop taking pills when going for the away match," says Isaac Koech, 36, who is a banker in Nakuru. "If you fail at home, your partner will understand that there are days when you perform. If you fail during an away match, you're doomed."

Some men are taking sexual performance drugs to get the most returns out of what they term as an investment. Jamleck Kinoti is one of these. The 33-year-old says that he takes pills to rip the maximum pleasure for the dates, gifts, and luxuries he has invested to win over his women. "It is an investment for which we endeavor to reap as much as we can," he says.

This can explain why men are not alarmed by the deaths of men who have succumbed to the pills.

Celebrated as heroes

A spot check on various social media platforms indicates that commentaries from men hail the victims as heroes and soldiers who succumbed in the line of duty. "Instead of sparking debate on the risks involved, these commentaries are inadvertently fueling usage. Most men feel that it is not so wrong or shameful to die in performance," cautions psychologist Frankline Oyoo.

Beyond the pressure to perform, stressors of modern-day living have limited the ability for men to rise to the occasion and driven younger men further into the usage of blue pills.

"Today, sexuality and daily living have become stressful for the modern-day man. He exists in a very competitive world. His chances at success are limited. He is jobless or financially insufficient to be fully relied on and all this results in very poor results sexually," says sociologist Nelson Muthama. The sociologist adds that the modern man's diet and sedentary lifestyle does not help matters.

How death occurs

How does the blue pill end up killing? According to Dr. Gitobu Mburugu, a Consultant Urologist at Kenyatta National Hospital (KNH), a combination of sexual enhancement drugs and other medications such as nitrates can be lethal. Dr. Mburugu says that these medications cause the blood pressure to drop to very unsafe levels.

Nitrate medicines – such as nitroglycerin – are used to treat or prevent angina which is a condition that occurs when blood flow to the heart muscle cells is insufficient. Nitrates are also used to treat chest pains that are the result of heart disease of the arteries in the heart. Blood pressure drop has also been highlighted as a possible side effect by the Pharmaceutical Society of Kenya.

The risk of death is imminent where the man is taking drugs for pulmonary hypertension, a type of high blood pressure. A look at Viagra's prescription warning issued by Pfizer lists conditions under which the drug can be lethal. These include having heart surgery within the last six months, have had a stroke, have a deformed penis, have sickle cell anaemia or leukemia, have kidney disease or is undergoing kidney dialysis, have liver problems, have bleeding problems, or have stomach ulcers.

"We caution the public against the use of sildenafil, tadalafil, vardenafil, and avanafil commonly known as "Blue Pill"," read Dr. Machogu statement.

Among younger men though, the long-term risk is the inability to perform without taking these pills. There is a risk of the body developing tolerance to the drug. This means that should a man suffer erectile difficulties in later years, medically prescribed sexual enhancement drugs will be ineffective.

Dennis Nyenze is learning this the hard way. The 36-year-old who runs a car hire business started taking sexual enhancement drugs in 2006. "I was 22. I started by experimenting with EnZoy, which was a popular sexual vitality powder that we diluted in soft drinks," he says. Dennis moved on to generic blue Viagra. "I have used sprays, gels, and even tried the 100mg overdose. I regret it all because today I cannot function without taking a pill. I have lost my natural abilities. If the body says quit or take it slow, just listen. Don't rush for the pill," he says.

The drugs, gels, and sprays

• Apart from tablets, men are buying gels and sprays over the counter and on e-commerce sites in Kenya. On the e-commerce platform, Jiji, men are buying the Maxman cream at Sh2,500. The cream promises sexual longevity and penile enlargement. The 50ml Beast gel is selling at Sh6,400 with the promise of longer sexual duration, pleasure, and penile enlargement.
• Apart from Viagra, other sexual enhancement drugs that are accessible over the counter include Cialis, VargX, Stendra, and Levitra. The originals of these drugs are costly and range between Sh1,000 per tablet and Sh7,500 per packet of four tablets. Herbal drugs such as Vimax go for as high as Sh1,800 per 60 capsules.

Mild to moderate side effects of sexual enhancing drugs

• Headache
• Nosebleeding
• Discomfort and pain in the upper abdomen
• Trouble galling and/or staying asleep
• Redness of skin
• Diarrhea
• Dizziness
• Skin rash

Severe side effects

• A mild and short-lived decrease in blood pressure
• Vision loss
• Unwanted persistent erection
• Potential for cardiac risk with sexual activity in patients with pre-existing cardiovascular disease

Steps to take in case of distress

According to Dr. Gitobu Mburugu, a Consultant Urologist at Kenyatta National Hospital (KNH), you can take the following steps in the event that your man looks distressed:

1. Stop the sexual activity immediately.
2. Lay the patient on the floor and lift their legs up above heart level.
3. Don’t feed them anything.
4. Urgently make a hospital emergency call or call for an ambulance.

At the hospital, inform the doctor that the patient had taken performance enhancement drugs. “Where the patient is administered with low blood pressure or has a heart condition, treatment may include nitrates to reverse these conditions.  If the patient had used sildenafil, the result could be catastrophic. The patient might be lost because the combination of nitrates and performance drugs could trigger a catastrophic

Quick facts

• According to Dr Gitobu, Viagra, Cialis, and Vardenafil are the most common types of sex-enhancing drugs. Vardenafil is sold under the trade names Levitra Vivanza, and Staxyn.
• Viagra is the brand manufactured by Pfizer, which is currently manufacturing the Covid-19 vaccine. It is available in 20mg, 50mg, and 100mg tablets.
• A 2013 study by the International Journal of Impotence Research, on Sildenafil, concluded that it does not improve erections in young healthy men. "Sildenafil should not be given to young healthy men to improve their erections and patients should be advised against recreational abuse of the drug," the report advised.