How to cash in on the sexual insecurities of men

A sudden rain at midday changed the sunny appearance of the Gulistan intersection. Mahbub Kaka (sic) wrapped up his makeshift sex treatment shop of tree roots and tablets on a footpath. He leaned on a footpath railing for the rain to subside. 

When I said hello, he took it for granted that I was a patient with sexual problems. "Sex problem?" Mahbub asked me in a lower voice.  

I said, "Yes, what treatment do you have?" Mahbub said that 'Trifola' would solve my problem. He didn't need to ask me details about the problem because "Trifola is the ultimate answer to all sexual problems," he said. 

Trifola is a mixture of different seeds including Amlaki, Myrobalan, Bohera, etc. 

Besides Trifola, Mahbub also sells various tablets for "lasting and enduring intercourses." But unlike other sex tablet sellers in the Gulistan intersection and different other areas of the capital, he is more focused on tree roots and herbs. 

"I have been selling these medicines here for over 40 years," Mahbub said, "my medicine cured many people of their sexual problems. Take my medicine in good faith, you will be cured." 

A tired-looking young man, possibly a transport worker, was nosing into our conversation. Mahbub asked the young man in front of me, "Sex problem?" The young man, visibly embarrassed, quickly left the place. 

In the meantime, I was bargaining the price of the Trifola that Mahbub was trying to sell. He fixed the rate at Tk100. I said, rather playfully, that I would buy it at Tk70. My offer convinced him. And Mahbub successfully sold me a packet of Trifola.    

When I was walking down the road in Gulistan with the Trifola packet in my hand, people around me were looking at it rather suspiciously. I put the packet in my bag to avoid any further unsolicited attention. 

I was at the Gulistan intersection that day to interview the sex tablet sellers who operate their businesses in the open, in different areas of the capital. 

Sex problems in Bangladesh are still veiled in shame and taboo. You will not see people talk about it openly because this is a "Gopon Somossa (Private Problem)" in this part of the world. 

As a result, a chain of bizarre treatment systems has emerged in Bangladesh targeting patients with sex problems. It includes unregistered tablet sellers cashing on the fear of men about sexual intercourse. 

I met a young man named Parvez near the Hanif flyover. He was selling various tablets such as EreX Plus, Elderin, SKD-Ginseng, SP-Nishat, Green Furti and Q-Rex. 

These so-called Unani medicines cannot be found on the Director General of Drug Administrator (DGDA)'s registered Unani product list on the website. That means these street vendors are selling these unregistered medicines openly in Dhaka streets. And the registered few Unani medicines that they have, they are selling them without any medical prescriptions. 

If you carefully look in Gulistan, Doinik Bangla, Fokirapul and Kawran Bazar, you will find plenty of street vendors like Pervez and Mahbub selling these tablets, and so-called herbs to cure sex patients. 

But they are not the only ones who are cashing in on the insecurity and fear among men.  

We have found some 'popular' Kabirajs (traditional doctors who prescribe alternatives to allopathic medicine - this can range from homoeopathy, herbs and, a combination of both with allopathic, or other solutions) online who sell 'Kabiraji' treatment to cure patients with sexual problems on Facebook and YouTube. 

One of them, Saiful Huq, who introduces himself as a madrasah principal, claimed he has over 30 lakh followers on social media. His YouTube channel Saiful TV has over 1.4 million subscribers and his videos have more than 107 million views. Saiful has other channels on YouTube and pages on Facebook too. 

Saiful's videos on Facebook are posted with bizarre captions such as, "this video is for those who ejaculate in less than a minute." He claims that his medicine that he calls 'Halua' is based on a recipe devised by a famous pir of his clan. 

It can cost something between "Tk3,000 to TK5,000 or more depending on your complications," Saiful told The Business Standard.  

To prove the authenticity of his medicine, Saiful showed 'proof' of his company's registration as Saiful Healthy Food Limited in one of his latest videos. When TBS asked him if he has a drug license, he said he didn't need any drug license because the 'Halua' he makes for curing sexual treatments are not drugs, they are a particular 'food.'

Unlike Saiful who has established a 'registered' business model with his 'halua' medicine in disguise of food, there are numerous other Kabirajs online who are not very advanced in business intricacies but, still, manage to cash in on the insecurities of men. 

One of them, Nupur Kabiraz claims that she came from Assam to Bangladesh. Her entire clan is Kabiraj. She takes money only after a patient is cured. 

When we called her to know more about her treatment procedures, she said that we have to send her two swans because she will make the medicine from the blood of the swan. If we cannot send swans, we will have to send her equivalent money. 

But, soon, as the conversation progressed, Nupur doubted if we really were a customer or inauthentic callers - perhaps because she didn't sense the insecurities she usually sees in a customer. She cut the call. 

Another Kabiraj Foysal Mahmud from Jhinaidah has a Facebook page named Zouno Roger Ses Chikitshalay (the last treatment of sex diseases). The popularity of his medicine is manifested on his Facebook page as he delivered his medicine to 74 people on 23 June and 52 people on 24 June 24, respectively.  

We asked him if he has a drug license. Foysal said he does and gave us the name and registration number of his company. We neither found the name nor the registration number he provided on the DGDA website. Subsequently, when we called him to ask about his company name's absence on the website, he did not respond. 

Principal Saiful says, in his videos, that among thousands of people with sexual problems he talked with, more than 90% are men. Given the size of his following, and the volume of medicines other Korbirajs are selling per day, it can be easily deduced that the number of patients with sexual problems and insecurities in Bangladesh is huge. 

What sustains this trade and what ails it 

So, why do these people not go to practising physicians instead of the Kabirajs? 

"When someone goes to a doctor with an issue like erectile dysfunction, it is really important to do a pre-check up because these medicines, in many cases, directly work on their blood vessel, [and] nervous system; and they create dose-dependent side effects on the liver, kidney, bones etc," said Dr Shusama Reza, Head of Sexual Medicine Unit and Consultant Dermatologist, LifeSpring Limited. 

"What a doctor may do, after a pre-check-up, is recommend low-dose medicines, followed by a second checkup after three months. When the low dose doesn't benefit much, many patients don't come and follow up after three months. At that moment, they fall for lucrative narratives of the Kabirajs," explained Dr Reza. 

"Now about the products that [Kabirajs and street vendors] are selling in markets, are these safe? A straightforward answer to this is this is not safe at all. 

These may turn out to be the reason for great danger. They don't care about drug laws, safety or doses. And when something happens to the patients, they don't care about them as well. You won't find stories of these patients [victims of wrong medicines] on [Kabirajs'] social media pages. 

Their biggest privilege is that they are free of liability. [Because sex treatment] has certain stigma and shame connected with it, victims who have entirely lost the ability to have sex won't speak up about this for fear of public shame. The Kabirajs are using this helplessness as an opportunity," Dr Reza further explained. 

Dr Reza pointed out that the Kabirajs' incorrect prescriptions have the potential to terribly damage our cardiovascular system, bones, liver, kidneys etc. 

"In many cases, the problem we wanted to solve, may be solved a bit initially, but for many, it may cause irreversible damage to sexual capacity and fertility," she said. 

Moreover, in most cases, the Kabirajs falsely market the same allopathic medicines that physicians prescribe as herbal medicine for " erectile dysfunction, premature ejaculation, or testosterone deficit," said Dr Reza. The catch is that they do it "in high doses, [for] longer duration, and inappropriately mixing things [plants, herbs] with them" and while there are benefits to using herbs, the "Kabirajs have no clue whatsoever about the original plants that help."  

"[For instance] a doctor would write 5 milligrams, [whereas a Kabiraj] is giving 10 to 15-milligram doses. It is never possible for our patients to differentiate between them," said Dr Reza. 

According to Dr Reza, sexual medicines are one of the cheapest medicines in medical sciences. Many people have misconceptions about sex, which can be fixed through merely a conversation. 

Many patients have performance anxiety. These problems can be solved with one/two small medicines. These medicines are not expensive in most cases. Only awareness can solve many of the issues.

She admitted that our social and religious norms encourage us to put the issue behind locked doors. 

"But there is no shame in disease. I may try to maintain secrecy but the mentality to surpass this shame should be created. And it falls within the ethics of being a doctor to keep your secret. It is true for all doctors, whether they treat sex or heart."

We reached out to Ayub Hossain, the Director of the Directorate General of Drug Administration (DGDA) for his comment. "Selling medicines on footpaths, or unregistered medicines are not allowed. There are laws in place to prevent them. We take steps against the hawkers and unregistered medicines," he said. 

Despite actions, it cannot be stopped entirely, he said, adding that other forces like the police [and] DB also come to their assistance. They also have the power to file cases against these entities under the special power act. 

"If someone is selling medicine online, ask them if they have a drug license. If they have a drug license, they can sell medicines," Ayub Hossain said, adding, "[yes] there are herbal food supplements that have medicinal qualities; we are going to draft a law, we will bring those under our regulation. If someone sells medicines - whether herbal or Unani - unless they have a drug license they cannot sell it." 

Dr Shushama Reza believes that strong implementation of drug laws will ensure that these Kabirajs and street vendors don't have the "audacity" of trapping people on he basis of their preconceived insecurities.