THE USE OF SILDENAFIL AMONG MALES IN BENIN CITY

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Sildenafil citrate was the first of a class of oral drugs called phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction (ED). It was first studied for high blood pressure and angina. Researchers noticed that it improved erections, so Pfizer marketed it for ED instead, and the US FDA approved it in March 1998 (Boolell et al., 1996). The drug works by blocking the breakdown of cyclic guanosine monophosphate (cGMP), which helps sustain an erection during sexual stimulation (Atsbeha et al., 2021).

ED is the failure to achieve or maintain an erection adequate for satisfactory sexual activity. It is estimated to affect about 322 million people worldwide, including about 30 million in Africa. It becomes more common with age and is linked to conditions such as diabetes and cardiovascular disease (Atsbeha et al., 2021). Sildenafil has proved effective and well tolerated in Nigerian men with ED. In an 8-week trial of 58 Nigerian outpatients, 95% reported improved erections, and headache (17%) and myalgia (3%) were the most common adverse events (Osegbe et al., 2003).

Use of the drug has spread well beyond medical treatment. Studies in several countries report recreational use among young, healthy men who want to improve sexual performance or confidence (Bechara et al., 2010; Harte & Meston, 2011; Gebreyohannes et al., 2016). A study in Gondar, Ethiopia found that two-thirds of users took sildenafil recreationally, most obtained it without a prescription and most learned about it from friends (Atsbeha et al., 2021). Researchers in other settings have also examined men who bypass the healthcare system to obtain PDE5 inhibitors (Schnetzler et al., 2010), and the findings in Ethiopia echo this pattern. A qualitative study in Addis Ababa likewise found widespread non-prescription use among young men (Both, 2016; Gebregeorgise et al., 2018).

This pattern raises health concerns. Sildenafil can cause headache, dizziness, flushing and visual disturbances (Ausó et al., 2021; Atsbeha et al., 2021). It needs special caution in people with cardiovascular disease (Cheitlin et al., 1999; Zusman et al., 1999). Combining it with alcohol, tobacco or illicit drugs may add further risk (Lindsey et al., 2012; Murtadha et al., 2021). Recreational use may also reduce confidence in natural erectile ability and lead to psychological dependence (Santtila et al., 2007).

1.2 Statement of the Problem

There is growing concern that many Nigerian men use sildenafil without medical advice, for sexual arousal rather than for diagnosed ED. Evidence from other countries shows that unsupervised use is linked to side effects, risky combinations with other substances and dependence (Atsbeha et al., 2021; Santtila et al., 2007). Despite this, little is known about how widespread sildenafil use is among males in Benin City, why they use it, where they get it and how much they know about its risks. This study addresses that gap.

1.3 Aim and Objectives

The study aims to investigate the use of sildenafil among males in Benin City. Its objectives are:

1. To determine the prevalence of sildenafil use among males in Benin City.
2. To identify the reasons for use, including medical and recreational use.
3. To identify the sources from which users obtain sildenafil and the sources of their information about it.
4. To assess users' awareness of its side effects and of risks from combining it with other substances.

1.4 Research Questions

1. How common is sildenafil use among males in Benin City?
2. Why do males in Benin City use sildenafil?
3. Where do users obtain the drug, and where do they get information about it?
4. How aware are users of its side effects and interaction risks?

1.5 Significance of the Study

The findings will give health workers, pharmacists and policymakers local evidence on how sildenafil is used. They can guide public education on safe use and support efforts to limit sales without a prescription. The study will also add to the limited Nigerian literature on non-medical use of PDE5 inhibitors and give future researchers a baseline.

1.6 Scope of the Study

The study covers adult males in Benin City, Edo State, who use or have used sildenafil. It examines prevalence, reasons for use, sources of the drug and of information, and awareness of adverse effects. It does not examine other PDE5 inhibitors or the effects of the drug on specific organs.

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