Recreational vs. therapeutic use of sildenafil among male users in the Republic of Kosovo

Background : Sildenafil is a commonly prescribed treatment for erectile dysfunction (ED), but its use has increasingly extended into recreational settings, particularly among young men. This shift raises public health concerns about misuse, unsupervised dosage, and associated side effects. Objective : This study explored how people use sildenafil both for medical reasons and recreationally. It examined who uses it, how often, and why they take it, as well as the side effects they experience, especially when it is combined with alcohol. Methods : A descriptive cross-sectional study was conducted from 1 December 2024 to 31 January 2025 in Prishtina, Republic of Kosovo. A self-administered questionnaire was distributed online and through pharmacies to men aged 18 years and older who had previously used sildenafil. The survey collected demographic information, reasons for use, frequency, dosage patterns, and reported side effects. Results : A total of 91 male participants were included. Most were between 18 and 29 years of age (45%) and from urban areas (67%). The majority reported using sildenafil without a prescription (72%), with doses of 50 mg (48%) and 100 mg (44%) being the most common. Improving sexual activity (58%) and boosting self-esteem (18%) were the leading reasons for use. Only 13% used sildenafil to treat medically diagnosed ED. About 22% combined sildenafil with alcohol. Side effects such as headaches, low blood pressure, and vision disturbances were reported more frequently among recreational users. Regression analysis revealed a significant relationship between higher dosage and increased self-esteem, as well as a reduction in blood pressure. Conclusion : Our findings indicate that many younger men are using sildenafil for recreational purposes, not solely for medical reasons. This kind of use is often associated with more side effects, possibly because doses are not properly regulated or sildenafil is taken alongside alcohol. These results underscore the need for enhanced public education on the safe use of sildenafil and more rigorous monitoring of non-prescription access to this medication.