WHERE"S THE ZEST? Stress seems to be affecting the libido of younger men

Viagra and predictability don't go together. Five years ago, scientists at the multinational company Pfizer found a chemical they had developed as an eye drug, sildenafil citrate, had failed. But curiously, male patients at the clinical trials were reluctant to stop taking their doses. The chemical, they discovered, rejuvenated certain parts of the male anatomy. Launched as the first effective pill for erectile dysfunction (ED)-impotence in everyday language- sildenafil, christened Viagra, became one of Pfizer's most successful drugs.

In January 2001, when sildenafil was launched in India, drug companies here hoped for a similar success. But unpredictably, sales have flagged. "We expected the market to be worth Rs 50 crore. It's only Rs 35-40 crore," says S.D. Kaul, director, Ranbaxy, whose Caverta is the most prescribed drug in the category, according to the Centre for Marketing and Advertising Research Consultancy. One startling reason: it's the younger lot and not the targeted age group that needs the drug.

SMALL-TOWN HIT: Ranbaxy's Caverta

FULFILLING THE PROMISE: Zydus Cadilla's Penegra

Analysis of nationwide sales shows that contrary to global trends, impotence in India appears to be a youthful phenomenon. "We had positioned 45-55-year-old men as our key target," says Kaul. His main customers turned out to be a good 10 years younger. In the absence of Indian data, companies based their projections on US studies, which showed that half the men in the 40-70 age group suffer from ED. Also, impotence is one of the symptoms of diabetes and India has the world's largest diabetic population (20 million).

"There is a rise in the number of diabetics with ED," says endocrinologist Ambrish Mithal.

Ranbaxy's data, however, shows that 35-45 year olds consume sildenafil most, followed by 45-55 age group and the 25-35 group. Those over 55-most likely to be impotent in the US-were least likely to be prescribed sildenafil in India.

It's not that men over 55 are youthful, only men that old do not take any action. Blame it on culture. "In the West, fathering a child at 75 is acceptable, not here" says Ajit Saxena, consultant urologist at Delhi's Indraprastha Apollo Hospital. Sandeep Vohra, president of the Delhi Psychiatry Association, agrees. "ED is definitely high in that age group," he says, "but after 55 there are other problems-high blood pressure, depression. So ED takes a backseat."

More disturbing is the plight of young men in the prime of life who have everything except a libido. Psychiatrists blame the pressures of life at that age for this; "35 to 45 is the time when people look for both personal and professional settlement. But that's when professional insecurity creeps in, bringing with it enormous pressure and stress," explains Vohra.

If sales figure are an indication, the young men with the problems appear to reside in smaller cities. "The majority of sales are in the smaller urban areas," discloses Kaul.

Though generally safe, sildenafil, a prescription drug in India, can be dangerous, even fatal, under certain medical conditions. These limits to prescription have been cited by the companies for the disappointing sales, especially in big cities. Of the around 10 Indian "Viagras", only Caverta and Zydus Cadilla's Penegra have shown a rising sales graph.

Men are still reluctant to admit to ED. "They come for depression or high blood pressure or other problems," says Vohra. "It's only when we probe a bit that we realise the real problem is ED." Sildenafil's greatest contribution perhaps has been to make ED acceptable as a medical disorder rather than a failure of manliness. But it is a slow process. Says Saxena: "Men are now visiting doctors instead of hakims and quacks." That's good news for the Indian makers of sildenafil, looking for market penetration.