Aphrodisiacs use and its client profile : An exploratory study in Aurangabad city , Maharashtra Dandekar RH

An aphrodisiac is defined as any food or drug that arouses the sexual instinct, induces veneral desire and increases pleasure and performance.1 The search for an effective aphrodisiac has been a perennial pursuit of most societies throughout history.2 The drug Viagra (sildenafil) has drawn public attention to aphrodisiacs. Various substances of animal and plant origin have been used in folk medicines of different cultures.3


Introduction
An aphrodisiac is defined as any food or drug that arouses the sexual instinct, induces veneral desire and increases pleasure and performance. 1 The search for an effective aphrodisiac has been a perennial pursuit of most societies throughout history. 2 The drug Viagra (sildenafil) has drawn public attention to aphrodisiacs. Various substances of animal and plant origin have been used in folk medicines of different cultures. 3 Worldwide estimates of impotence or erectile dysfunction (ED) prevalence range from 2% in men younger than 40 year to 86% in men 80 year or older. Despite this,few numbers of cases come to light. 4 The commercialization of new synthetic love drugs has fascinated the public interest and has led to a reassessment of classical aphrodisiacs and to the search for new ones. The practice of self-medication by an increasing number of patients, the incessant aggressive advertising of these herbal aphrodisiacs, the invasion of the medicinal market with uncontrolled dietary supplements and the absence of real directives amplifies the potential health hazards to the community. 5 There are many herbal drugs that have been used by men with ED with varying degrees of success. Most potent herbal aphrodisiacs are available and have little or very little side effects. 6 Vajikaranas i.e. measures to excite lust by charms, are two kinds, 1) the external or mechanical methods as flagellation, scarification and external application on male or female genitals or extra-genital parts and 2) the medicinal or oral preparation to excite sexual passions. 7 The placebo effect is one scientific stumbling block for food and over the counter (OTC) drugs to affect sexual appetite. Despite the United States FDA (Food and Drug Administration) determination that OTC aphrodisiacs are ineffective and sometimes even dangerous, people continue the optimistic quest for drug-induced sexual success. 8 Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of the first pharmacologically approved remedy for impotence, Viagra, in the 1990s caused a wave of public attention, propelled in part by heavy advertising. 9 Till date, there were no studies regarding various aphrodisiacs use and its client's profile. Hence, in order to find out various Aphrodisiacs used by the clients and profile of clients, the present exploratory study was conducted in Aurangabad city, Maharashtra.

Material and Methods
A cross-sectional study was conducted at Chemists and Druggists Medical Stores during six months period from December 2009 to May 2010.There were about 847 Chemists and Druggists Medical Stores in Aurangabad city. Pretested questionnaire showed that in each medical store, there were average 4 to 6 clients coming to purchase aphrodisiacs. Hence, taking into consideration the time required to gather data, 5% (47) medical stores were selected by Systematic Random Sampling method. Thus 218 clients were studied who were found while purchasing the aphrodisiacs.
The investigator had paid one day visit to each medical store. He studied the prescriptions and recorded aphrodisiacs purchased by the clients with or without having prescription i.e. OTC. The clients were interviewed for their demographic characteristics such as age, education and occupation. The data was collected after their consent regarding the reasons for aphrodisiacs use, sources of their information, frequency of aphrodisiac use, various brands and their Systems of Medicine i.e. Allopathic, Ayurvedic, Homeopathic and Unani.
The cafeteria approach was used by the Chemists and Druggists for those groups of clients who were purchased aphrodisiacs by OTC. After selecting an aphrodisiac, they were given instructions by chemists regarding its use. The desire as a reason for use of aphrodisiacs was expressed by the clients and was in search of more pleasure during sexual intercourse. The medical reason was erectile dysfunction or impotency. Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. 10

Statistical Methods
The data was analysed by using Epiinfo 3.5.1 software package and interpreted in proportions and chi-square test.The p values less than 0.05 were taken as statistically significant.

Results
In this study we found 218 clients who purchased aphrodisiacs at Chemists and Druggists Medical Stores. IJBR (2013) 04 (09) www.ssjournals.com In this study maximum number i.e. 150(80.65%) educated clients were purchased aphrodisiacs by OTC. Also 99(82.50%) employed clients were engaged in purchasing aphrodisiacs by OTC. However, both education and occupation status were statistically not associated with purchase of aphrodisiacs by OTC.
The present study showed that 177(81.19%) clients were purchased aphrodisiacs for sexual desire as reason and 41(18.81%) clients for medical reason. The proportion (88.14%) of clients purchased aphrodisiacs by OTC for sexual desire was significantly more than medical reason. Regarding frequency of aphrodisiacs use, 7(3.21%) clients were daily user, 101(46.33%) clients twice weekly, 64(29.36%) weekly and 46(21.10%) monthly. The print and electronic media were contributed to 99(62.66%) clients as the source of information regarding aphrodisiacs. However source of information was not significantly associated with the purchase of aphrodisiacs.
The distributions of clients in terms of aphrodisiacs with their Systems of Medicine were as, 44(20.18%) clients used allopathic aphrodisiacs and 174(79.82%)clients as other systems of medicine than allopathy. More clients use aphrodisiacs from other Systems of Medicine than allopathy. The clients who purchased aphrodisiacs by OTC were significantly associated with Systems of Medicine.
The present study showed that there were88 different aphrodisiac brands sold in Aurangabad city. One strip of allopathic aphrodisiac has 4 tablets. Other Systems of Medicine strips have 10 capsules. Combined brands were also available in ayurvedic preparations containing capsules and oil in one pack. Tablets and capsules were instructed to consume half an hour before sexual intercourse preferably along with milk. Oil massage was suggested on external genitals just before the act.

Discussion
In the present study 80.28% clients were purchased aphrodisiacs by OTC and 19.72% clients with prescriptions. These findings are similar with a study by Makwana S et al that 78.26% clients acquired aphrodisiacs at medical stores by OTC and 21.74% clients with prescriptions. 11 Significantly higher OTC use of aphrodisiacs was observed among under 21yeas of age clients(91.11%); older clients consulted doctors before aphrodisiac use. It may be due to medical reason more than sexual desires. While the statement that client age was the variable most strongly associated with impotence may be true as suggested by Feldman HA et al, the present study does not support it. 12 The present study showed that use of aphrodisiacs is more among clients above 21 years of age(79.36%).
In India, the age of marriage for male is 21 years, but the clients below 21 years of age were engaged in indiscriminate sexual behaviors. This is in agreement by Tapert and Kotchick et al. 13,14 A studies by Makwana et al showed that 23.65% clients were in age below 21 years which is nearly similar to our study (20.64%).
Our study showed that 85.32% literate client and 55.05% employed clients were engaged in the purchase of aphrodisiacs. These finding are similar with MakwanaS et al that 50.78% employed clients were using aphrodisiacs. This study showed that more proportion of clients (79.82%) use aphrodisiacs from other Systems of Medicine than allopathy. Also significantly higher percentage of clients uses OTC aphrodisiac among other Systems of Medicine (82.18%) than allopathy.
In this study there were 18.81% clients who purchased aphrodisiacs for the medical reason. This necessitates prevalence studies for impotence or ED. Sexual desire as the reason to purchase aphrodisiacs was significantly associated with OTC purchase of aphrodisiacs. In our study we found 18.81% clients purchased aphrodisiacs for medical reason and 81.19% clients for sexual desire. In a study by MakwanaS et al only 9.78% clients purchased aphrodisiacs for medical reason and 90.22% for sexual desire. As compared to our study less percentage of clients used aphrodisiacs for medical reason than Makwana S et al. This might be due to online client's response to questionnaire by MakwanaS et al.
The present study revealed that 218 clients were purchased 88 brands of aphrodisiacs. The most popular aphrodisiacs brands purchased by clients were ayurvedic (44.32%). The use of artificial genitals and intra-corporal aphrodisiacs were not found in our study.

Conclusions
This study revealed that the clients were preferred to purchase aphrodisiacs by OTC. Below 21 years of age clients were engaged in sexual behaviours as they had more in number to purchase aphrodisiacs by OTC. The print and electronic media renders the major source of help for clients to purchase aphrodisiacs. The clients preferred to use aphrodisiacs from other systems of medicine than allopathy and majority of choice was ayurvedic aphrodisiacs. The publicity of aphrodisiacs products should be regularised and the use of aphrodisiac with prescription is encouraged. These measures can serve to prevent the health hazards to the community IJBR (2013) 04 (09) www.ssjournals.com