Arousing Debate in Egypt

With the possible exception of the Palestinian conflict, few events have been as widely discussed here, as deeply debated. Newspapers, magazines and office gossip in contemporary Egypt have all focused on the same pressing issue:

When will Viagra be on store shelves?

The little blue pill that fights male impotence has been illegal here since it first hit the global market, although it is routinely smuggled and widely available at a premium. A former health minister banned the drug, saying it “would destroy family relations.”

The current minister has moved to lift the ban, a decision that will make Viagra, while still expensive for most Egyptians, a lot cheaper. Prices are expected to drop by half, from about $10 per tablet on the black market.

“Egyptian Men Soon to Be Virile in Bed,” announced a recent front-page headline in the English- language Egyptian Mail, in a story hailing the minister’s decision. “My fellow men, it’s time to rejoice,” the article concluded.

But it is not just Viagra’s medical effectiveness that has made it such a hot topic. To talk about Viagra is to confront many of Egypt’s most pressing issues, from an unmanageable population explosion, to government corruption, to the anxieties of a conservative religious society where neither men nor women are taught much about their own bodies.

This is still a country where most women undergo genital excision and where discussing sex between a husband and a wife remains taboo--facts that have also fueled the Viagra dialogues.

“There is lack of early marriage, economic troubles, lack of apartments for the ordinary middle class, a lack of economic means, and the population is suffering,” said Dr. Aziz Khattab, 77, a pioneer in sex education in Egypt. “If you propagate love in Egypt, it will be the solution to lots of Arab problems.”

Egyptians are good at making jokes and poking fun at themselves, and Viagra has spawned its share of quips, like the one told by a religious scholar involving the man who took five Viagra tablets and died. “There was only one thing standing up when guests came to pay their condolences,” joked Abdel Sabur Shaheen, a linguistics professor and widely respected religious thinker in Egypt.

But these are serious issues, issues that Shaheen and his community are struggling to come to terms with, issues that cut to the core of this tradition-bound developing country. Take the case of young men: They are terrified of their wedding nights. Not all of them, of course, but enough that Khattab said he put a whole chapter titled “Wedding Night Syndrome” in his textbook on human sexuality.

It’s true, said Tarek Shabrawy, a 25-year-old pharmacist in Cairo. He said young men often buy Viagra and a sensation-killing “delay spray” to help consummate their marriage.

“Here in Egypt, we have no experience before marriage,” Shabrawy said. “We have something inside us that frightens us. So some guys take drugs to help.”

Shabrawy explained, however, that this is a more complex issue than the common psychological stress of performance anxiety. It has its roots in social conventions that demand that men buy a home and pay a bride price before they can get married. But the economy is so bad, unemployment is so rife and housing is so limited that few young men can meet the requirements--especially in the big cities--and so they must wait.

“In the states, they condone sex before marriage, but here that is a problem,” he said.

Then there are matters of religion. Under Islamic law, a woman may initiate a divorce if her husband doesn’t gratify her sexually. (Of course, it’s difficult for a woman to prove that to the satisfaction of the male-dominated system.) “If a man can’t satisfy his wife, she may commit adultery and that may open the door to prostitution,” said Shaheen, the religious scholar. “To protect against sin if he can’t satisfy her, she has the right to divorce.”

Talk about pressure.

Finally, there are complications that stem from values linked to a traditional way of life outside the teachings of Islam. Among them is the much-criticized practice of genital excision, widely known here as female circumcision.

According to the most recent comprehensive health survey, conducted in 2000, 97% of women of child-bearing age in Egypt reported having undergone the procedure, and Khattab said half of those women cannot reach a climax during sex. One physician in his 20s said that excision, while catastrophic for women, puts added pressure on already performance-conscious men. Many, he said, turn to Viagra, or at least want to.

“Everybody is using it,” said Ahmed Tantawy, 25, another pharmacist. “They think they will be stronger if they take it.”

An Ancient Quest

This interest in performance enhancers is hardly new. For centuries, Egyptians have turned to herbal remedies, like the mixture of more than 16 herbs called “Happy Life” sold in a renowned herb shop here.

“Maybe all the men are afraid women will go with strangers,” said Abdullah Salah, the manager of a nearby spice shop. “So they take this stuff to make them stronger and more satisfied.”

The obsession with sexual aids is almost as old as Egypt itself. The country’s chief of antiquities, Zahi Hawass, said that during the New Kingdom, about the 13th century BC, Ramses II also looked for a little pick-me-up. In portraits of Ramses, “he is always depicted with a strong erection,” Hawass said. “But how does he get that strong erection? Through lettuce. Lettuce was the Viagra of today.”

In modern Egypt, the complex issues associated with human sexuality have had such a ripple effect across society that a prominent filmmaker, the late Salah abu Seif, tried for 30 years to address them in a film he wanted to call “The Sex School.”

The plot revolved around a husband and wife who were unable to satisfy each other. The couple went to a therapist and discovered that the woman had problems because she always recalled the day she underwent excision, and the man was troubled because of a bad experience he had with a prostitute. The therapist helped them get past their problems. But state censors stopped Abu Seif from ever making the movie.

This year, his son Mohammed, also a filmmaker, changed the name to “The Peacock and the Ostrich,” and it was finally shown to the public in March.

“Viewers may not imagine that the film addresses a problem that existed 30 years ago and still does,” wrote a reviewer on an Arab- language Web site. “The film demonstrates that society views sex as a taboo, even between husband and wife.”

Many of these issues--not just personal, but also institutional--are being discussed in the context of Viagra. Originally designed as a vascular dilator to lower blood pressure, the drug, the Pfizer pharmaceutical company noticed, improved blood circulation, helping men with erectile dysfunction.

It has become one of the most prescribed medicines worldwide, including in the Muslim world, since first entering the market in April 1998.

But not in Egypt. In addition to being destructive to the family, health officials charged, it could undermine Egypt’s efforts to control the growth of a population that has surged from 20 million in 1952 to about 67 million today.

Many people here believe the ban had little to do with health concerns and everything to do with a government bureaucracy that is either incompetent or corrupt. Keeping the drug illegal did make a lot of people rich. Viagra is reportedly the No. 1 smuggled item in Egypt, and in the last two years, customs police have seized at least 765,000 pills.

But many more pills make it into Egypt. Traders travel to Syria, China, Jordan or India, where they buy huge quantities of Viagra, or a locally produced generic equivalent. In Syria, for example, it’s called Viga. The drugs are then carried in ordinary suitcases through the airport to Mosky Street in central Cairo, known for wholesaling smuggled pharmaceuticals.

“Sales associates” distribute the goods to pharmacies around the country. Two pharmacists estimated that 85% of all pharmacies in Egypt carry Viagra. It’s sold under the counter to anyone who asks, they said. Prices vary depending on where the drug was manufactured. Although many Egyptians are boycotting U.S. products because of Washington’s support for Israel, when it comes to Viagra, people want American.

In some cases, Egyptians have offered to pay up to 100 pounds ($22) per tablet.

Just this month, Pfizer said it received permission from Egypt’s government to begin producing and selling its profitable drug here, and a company spokesman said Viagra should be on the market--legally--within a month. Pfizer expects more than $10 million in annual sales in Egypt.

Though there was no formal declaration as to why Viagra is being approved now, the government decision recognizes that, even with the ban, it is on the market and that, by lifting the prohibition, Egypt stands to benefit economically through increased tax revenue and jobs for pharmaceutical workers.

Egyptian drug companies are pressing for the right to make a generic version; if they do, the price could be as low as $1.50 a tablet.

‘Viagra Became Famous’

But legal Viagra still has many people worried--and on many different levels. To begin with, Egyptians have the impression that Viagra is an aphrodisiac. Its reputation has become so widespread that physicians report men slipping Viagra into women’s drinks. One man said he was paying his lawyer in Viagra tablets. Another said he managed to get permission to add three stories to his apartment building by bribing a state official with a few Viagra tablets.

“Viagra became famous,” said Salah, the manager of the spice shop. “It is something new to Egyptians, and that is why all Egyptians want to try it.”

Another problem is that Egypt’s pharmacies sell almost anything to anyone. The law, for example, doesn’t require prescriptions for strong antibiotics; therefore, many people self-medicate. It does require a prescription for sedatives, but those also are sold to almost anyone who asks.

Although officials said they expect that the government will restrict Viagra use to prescriptions, drug companies say there is no reason to believe that the system will suddenly work.

And Shaheen, the religious scholar, believes that as soon as Viagra is widely available, the population will explode.

“If you bring Viagra to Egypt, after 20 years, the population will increase by 100 million,” he said. “When Viagra comes, it will be like hashish. Anyone will take it, not only people with medical problems.”