SINGAPORE - They are cheap and no prescription is needed
A cabby still recalls a night of fun in 2008 that later made him swear off illegal sex-enhancement pills.
"It was after our shift. My friends and I went drinking and then one suggested we go to Desker Road to have a bit of fun," said the 56-year-old, who wanted to remain anonymous.
"We bought the pills from a peddler there and popped a few each," he said, adding that he felt "like a tiger" while having sex with a prostitute in that red-light area.
"I was high but I was able to go on for a long time," he said. He became scared when he felt constantly thirsty the next day. "Throughout the day, I was drinking so much water, yet I was unable to quench my thirst," he noted.
He suspected that it was a consequence of taking the pills and swore not to do so again.
That same year 10 men, aged between 35 and 84, died from taking illegal sex pills. Several others fell into a coma.
Early this month, four men, aged between 30 and 78, were hospitalised with dangerously low blood-sugar levels after taking illegal sexual-enhancement products.
Two were unconscious when they were taken to the hospital while the other two were confused and weak.
Medical experts said keeping the libido up and getting a quick fix for erectile dysfunction (ED) problems are among the reasons customers patronise backstreet "pharmacies" and online peddlers - even when there are no guarantees that the drugs are bona fide, and despite the fact that they have caused fatalities previously.
The buyers are from all age groups: some in their 20s, one as old as 84.
While authentic drugs cost about $20 a pill, imitations go for $2 and "non-branded" items cost as little as $1.
Clinical sexologist Martha Lee said the younger lot seemed to pop such pills for "recreational purposes".
"Because they are young, they don't have sexual difficulties. All these guys want is to last longer and stay harder but they can't go to a doctor to get Viagra or Cialis so they turn to backstreet peddlers," she said.
Viagra, Cialis and Levitra are the three oral drugs approved for the treatment of ED, or impotence, in Singapore.
They increase blood flow to a man's penis so that he will get an erection when sexually stimulated. They are available only by prescription.
According to the Health Sciences Authority (HSA), backstreet pills - mainly made in China - are often adulterated. Glibenclamide, a prescription drug for diabetes, was found in the urine and blood of the four men and identified as the cause of their dangerously low blood-sugar levels.
Glibenclamide had been found previously in illegal sexual-enhancement health items confiscated by HSA, such as Power 1 Walnut and Singapore Power 1.
Some pills also contain sildenafil, the ingredient in Viagra.
Power 1 Walnut, for example, was found to contain 90mg of glibenclamide, about five times the amount prescribed to a diabetic patient, and 7mg of sildenafil, far below the 25mg to 100mg needed to trigger any sexual enhancement effect.
These quick fixes have caused seizures, coma and death.
Dr Lee said she is not sure whether those who go for illegal pills are aware of the side effects, "let alone the ingredients", adding they often believe they are not so "suay" (ill-fated in Hokkien) to suffer the consequences.
Increasingly, generic drugs, rather than fake Viagra and Cialis, are also being sold online and on the streets.
These contain the same ingredient as Viagra or Cialis and are made in countries without laws recognising product patents. They are also sold at much cheaper prices.
A council member of the Pharmaceutical Society of Singapore, Ms Fatimah Kutty, said Singapore abides strictly by international patent laws.
"All drugs must be properly registered. If the patent still stands, then its generic version is not allowed here," she said.
A study published in the Singapore Medical Journal in 2003 found that 51 per cent of 729 subjects aged 30 and above reported some degree of ED.
Professor Kesavan Esuvaranathan, head of the Department of Urology at the National University Hospital, said he sees three types of ED.
"The first is psychogenic, caused by stress at work and demands from spouses. This can often be treated with counselling or a good vacation," he said.
The second type is caused by low testosterone levels and diagnosed with a blood test. "Often, these men are overweight. I would encourage a healthier lifestyle to put things right."
The third cause is organic. "It is the narrowing of the blood vessels to the penis and this tends to cause ED. This group is prescribed sildenafil," he added.
But he cautioned that they have to be monitored closely as narrowing of blood vessels can indicate more serious problems. "More often than not, these men suffer heart attacks five years down the road so we have to constantly evaluate their health," Prof Kesavan said.
Psychiatrist Adrian Wang said some men feel that taking an ED drug can enhance their pleasure.
"It may just be a placebo effect in some cases but they feel stronger and hence get more satisfaction," he added.
Dr Lee said a lot of men here are not "well-schooled in sex education or the functions of their own bodies". "They have the misconception that they have to stay rock-hard from start to finish and that premature ejaculation means they make poor lovers," she said.
"But when the man is concentrating on pleasing the woman, his full focus will be on her. There is nothing wrong with him when he remains soft at that point," she explained.
Many men also do not feel comfortable sharing their problems with doctors. Said Dr Lee: "Many would turn to quick fixes like pills off the street, often putting their own health in danger."
Meanwhile, the authorities are not letting up on efforts to curb the activities of sellers of illegal drugs. Associate Professor Chan Cheng Leng, director of the Vigilance Division at the HSA, urges people not to buy dubious pills from friends, relatives or hawkers: "Go and see a doctor to get the proper medicines."
There is also more to intimacy than the sexual act.
Prof Kesavan said: "Man must learn that a one-night stand is like having a burger at a fast-food place. Once the act is done, it's gone. But sharing intimacy with a woman he loves is like eating at a fine-dining restaurant. You not only enjoy the food, but also the ambience and the company."
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