"Every Time You Have Sex, You Must Use an Enhancing Substance." Erectile Dysfunction and Its Treatment Among Young and Adult Males in Dar es Salaam, Tanzania: A Mixed-Method Study

Background
Erectile dysfunction (ED) is one of the underexplored conditions commonly affecting older adults. Recently, it has been reported even among younger men and linked to the use of sex-enhancing substances (SESs). The determinants of ED and the impacts of using SESs are poorly understood. We determined the proportion of ED, its associated sociodemographic factors, and explored the awareness of ED and the types of SES used among young and adult men in Dar es Salaam, Tanzania.

Methods
We conducted an explanatory mixed-method study employing an analytical cross-sectional study design for the quantitative arm and a case study design for the qualitative arm. We collected data in June 2024 among 503 young and adult men in the Ilala district, Dar es Salaam. We used frequency and proportions to summarize categorical data and logistic regression to determine the sociodemographic factors associated with ED. Thematic analysis using an inductive approach was used to analyze qualitative data.

Results
The proportion of young and adult males with ED was 29.2% and most participants in qualitative arm incorrectly defined ED. Compared to participants aged 20–35, those aged 36–45 years were 2.39 (95% CI: 1.23–4.74) times as likely to have ED. One hundred and seven (21.27%) participants reported having ever used SES reasons being an easy availability, affordability, and good customer care from the SES sellers. The most commonly mentioned SES was Congo dust “Vumbi la mkongo”.

Conclusion
The proportion of ED among young and adult males was high, with older men being highly affected. SES use was reported even among participants with no ED. We recommend further exploration of the chemical contents of SES alongside improving regulatory practices to guide community access to SES. Additionally, public health interventions should also focus on promoting male sexual reproductive health.