Non-medical use of phosphodiesterase 5 inhibitors for sexual enhancement among young healthy university male students in Tanzania: A cross-sectional study

Abstract

Background: Phosphodiesterase-5 inhibitors (PDE5i) are approved for erectile dysfunction but increasingly misused by young men without medical indications. Such non-medical use raises concerns about adverse effects, drug interactions, and risky sexual behaviours.

Objectives: To determine the prevalence and factors associated with recreational use of PDE5i among healthy male university students in Tanzania.

Methods: This was a cross-sectional study conducted at the Catholic University of Health and Allied Sciences (CUHAS) between April and July 2020, involving male undergraduate students enrolled in medicine, pharmacy, nursing, laboratory sciences, and diploma programmes. A semi-structured online questionnaire was administered via a secure Google Forms platform, with an embedded electronic informed consent form completed before enrolment. Data collected included participant demographics, medical history, substance use, and PDE5i-related knowledge and practices. Logistic regression was used to determine independent factors of PDE5i use.

Results: A total of 196 male undergraduate students were enrolled, with a mean age of 24±2.2 years, and 7.7% (15/196) reported PDE5i use. Most accessed drugs without prescription (60%), mainly sildenafil (73.3%). Common side effects included headache (53.3%) and dizziness (46.7%). Older age, cigarette smoking, alcohol consumption, and having a sexual partner were associated with use in crude analysis, but only older age (AOR 4.04, 95% CI 1.20–13.61) and cigarette smoking (AOR 6.8, 95% CI 1.17–39.4) remained independent predictors.

Conclusions: Non-medical PDE5i use for sexual enhancement was present among university students, associated with older age and cigarette smoking. These findings highlight the need for awareness of the risks of misuse and stricter regulation of non-prescription access.