Factors influencing the use of sex enhancement drugs among young people in Malawi

By Centre for Youth Empowerment and Civic Education – Youth Researchers Academy

Principle Investigator: Edward Chikhwana MSc

Researchers: Chimwemwe Chisale, Brenda Matewere, Naomi Banda, Emeless Ngolomi, Yamiko Banda, Moses Likwemba, Tapiwa Nyasulu

Introduction/background

Recent reports of young men collapsing and dying after using sex enhancement drugs have raised serious public concern in Malawi. Police records indicate that at least 42 sudden deaths have been recorded between January and May 2026, with many suspected to be linked to the use of drugs and substances intended to enhance sexual performance (Nyasa Times, June 2026). The desire to enhance sexual performance is driving a growing number of young people in Malawi to use sex enhancement drugs, often without medical guidance and with little understanding of the potential health consequences.

The study conducted by the Centre for Youth Empowerment and Civic Education (CYECE) – Youth Researchers Academy (YRA) provides important insights into this emerging issue. The cross-sectional study that was conducted in Lilongwe urban and Dedza rural targeting young people aged 18 to 30 years old, revealed the factors that influence young people to use sex enhancement drugs; the social complications of using sex enhancers, including young people engaging in unprotected sex and having multiple sexual partners and current gaps to reduce the use of sex enhancement drugs among young people. The study used a cross-sectional approach where a mixed-methods approach was employed. Structured questionnaires were used to collect quantitative data, while focus group discussions and key informant interviews were used to collect qualitative data.

Reasons Behind Sex Enhancement Drug Use Among Young People

The study found that the use of sex enhancement drugs among young people is primarily driven by the desire to enhance sexual performance, increase sexual stamina, boost libido, and prolong sexual intercourse. The majority of participants (85.9%) believed that these drugs improve sexual performance by increasing libido, extending the duration of sexual activity, and strengthening intimate relationships.

The study found that social and cultural norms play a significant role in influencing the use of sex enhancement drugs among young people. Participants reported feeling pressure to demonstrate masculinity, satisfy their partners, improve sexual confidence, and meet perceived expectations of sexual performance. Peer influence and the widespread promotion of sex enhancement products further contributed to their growing use among young people.

The study also highlighted the influence of cultural norms in normalizing the use of sex enhancement products. One participant from the Lomwe ethnic group explained that sex enhancement products are commonly sold during the annual Mulhakho wa Alhomwe cultural festival, making them highly visible and easily accessible within the community. As one participant stated:

“I am Lomwe, and every year during the Mulhakho wa Alhomwe celebrations, these products are openly sold. Many people buy them as they are seen as part of the celebration, and this encourages people, especially young men, to use them.”

These findings suggest that cultural events and social norms can create environments in which the use of sex enhancement drugs is normalized, reinforcingbeliefs about masculinity, sexual performance, and relationship expectations.

The study also found that the easy availability and perceived safety of herbal products encourage their use. Approximately 71% of participants were familiar with herbal sex enhancement products, citing their affordability, accessibility, and widespread marketing as “natural” and safe alternatives. By comparison, 54.7% of participants identified Viagra as the best-known pharmaceutical sex enhancement drug, which was perceived as more effective and faster acting but less affordable and less accessible than herbal products.

The study revealed that poor communication between sexual partners may contribute to the use of sex enhancement drugs among young people. Many young people may experience difficulties openly discussing sexual expectations, concerns about sexual performance, satisfaction, and health with their partners. As a result, some may turn to sex enhancement products as a way of addressing perceived sexual difficulties without first communicating with their partners. The findings further showed that 84.31% of users did not disclose their use of sex enhancement drugs to their sexual partners before engaging in sexual activity. This lack of communication may reflect fear of judgment, embarrassment, pressure to meet perceived expectations, or concerns about appearing sexually inadequate. It may also prevent partners from discussing safer and healthier ways of addressing sexual concerns.

Social complications associated with usage of sex enhancers

Increased risk of unprotected sex: According to the study, 72.9% of participants who had taken sex enhancement medicines said they had unprotected sex while under the influence of these substances. Participants clarified that condoms were thought to lessen the medications’ intended effects, making them more susceptible to HIV, STIs, and unwanted pregnancies. “I cannot use any form of protection after taking sex enhancement drugs because the purpose of using the drugs is to maintain the sweetness (pleasure) of sex,” stated one participant.

Multiple Sexual Partners:The findings reveal that sex enhancement drug use is associated with having multiple sexual partners. 61% of participants who reported having two sexual partners also reported using sex enhancement drugs compared to 66% of participants with one partner who reported not using them. These behaviours increase the risk of sexually transmitted infections (STIs), including HIV and other sexual and reproductive health complications. Although sex enhancement drugs may temporarily improve sexual performance, they provide no protection against these risks.

Physical Injuries, Irritation and Infections:The study found that the use of sex enhancement drugs is accompanied by unsafe practices that may place young people at risk of adverse health outcomes. Qualitative findings revealed that some participants reported using unverified methods as a way of improving sexual pleasure or enhancing sexual performance. These practices included inserting garlic or ginger into the vagina and using chilli plant roots (muzu watsabola), water and lemon to improve sexual pleasure. Such practices can result in physical injuries, irritation, infections, and other reproductive health complications. Some of the participants reported that

P5: “For example, women are advised to insert garlic or ginger into their private parts as a way to tighten the vagina.” Supporting this, P7 stated that “some women are advised to wash their vaginas with these drugs, which can lead to issues such as wounds in the vulva.”

Additionally, one of the male participants emphasised that “the use of these drugs is harmful and can cause serious problems. For instance, some men are advised to apply lemon juice to their penis as a method to enlarge it, which can lead to other complications.”

Current Gaps Related to SRHR and the Use of Sex Enhancement Drugs Among Young People

Easy Access to Unregulated sex enhancement products

The growing use of sex enhancement drugs among young people highlights significant gaps in the regulation, monitoring, and control of these products. The study found that many herbal and pharmaceutical sex enhancement products are accessed outside formal health systems, making it difficult to guarantee their safety, quality, effectiveness and appropriate use.

While some participants reported obtaining these products from licensed pharmacies, a large proportion accessed them through informal channels. 57.03% of participants indicated that they obtained sex enhancement drugs through friends, demonstrating how peer networks contribute to the availability and distribution of these products. Other sources included street vendors, local markets, and online platforms, where products are often sold without adequate information on ingredients, dosage instructions, possible side effects or medical guidance.

The availability of these products through unregulated channels creates risks for young people, as some products may contain unknown substances, incorrect dosages, or potentially harmful ingredients. Without proper quality assurance and regulatory oversight, users may unknowingly consume products that could result in adverse health effects.

Limited Knowledge of Health Risks

Although awareness of sex enhancement drugs was high among participants, the study revealed a critical gap in understanding their potential health risks. Only 56.82% of participants were aware of the possible health implications associated with these products, suggesting that many young people may use sex enhancement drugs without adequate knowledge of their consequences. It was also found that misconceptions about the safety of herbal products were common, with some participants believing that products marketed as “natural” were automatically safe.

The combination of easy access to unregulated products and insufficient knowledge about health risks increases the likelihood of misuse, unsafe sexual practices, and exposure to preventable health complications. This indicates that awareness campaigns should move beyond simply informing young people about the existence of sex enhancement drugs and focus on providing accurate information about possible risks, safe decision-making and available sexual and reproductive health services.

Recommendations/ Looking Ahead

1. Strengthen Comprehensive Sexuality Education

CSE should be strengthened to equip young people with accurate, age-appropriate and evidence-based information on sexual and reproductive health. It should address healthy relationships, consent, harmful gender norms, myths and misinformation, media influence, safe use of medicines and the risks associated with using sex enhancement drugs without medical advice.

2. Strengthen Regulation and Monitoring of Sex Enhancement Products

There is a need to strengthen the regulation and monitoring of the sale, advertising and distribution of herbal and pharmaceutical sex enhancement products, particularly those sold through informal markets and online platforms.

3. Expand Public Awareness and Health Information Campaigns

Public awareness campaigns should be expanded to dispel myths and misinformation surrounding sex enhancement drugs and provide young people with accurate information about their potential health risks.

4. Strengthen Research and Evidence Generation

Further research is needed to better understand patterns of sex enhancement drug use, their long-term health effects, and effective interventions for reducing harmful use among young people in Malawi.

6. Promote Coordinated Multi-Stakeholder Action

Policymakers, health professionals, educators, communities and other relevant stakeholders should work together to address the growing use of sex enhancement drugs. This issue extends beyond individual behaviour and reflects broader gaps in education, regulation and access to accurate sexual and reproductive health information.

7. Integrate Sex Enhancement Drug Risks into CSE and SRHR Programming

As Malawi continues to invest in adolescent and youth sexual and reproductive health, information on sex enhancement drugs should be integrated into relevant CSE and SRHR programmes. This can help young people critically assess information, challenge myths surrounding sexual performance, make informed decisions and reduce associated risky behaviours.

@cyecemw