London-based Dan, 28, began using Viagra when he started sleeping with men, back in university. “I felt a lot of pressure to be confident with men because I was inexperienced and nervous, which would have made it harder to enjoy,” he tells Dazed. Due to being on antidepressants, Dan had trouble maintaining an erection – a common side effect of antidepressants – so he decided to speak to his GP. “He advised me to buy online instead of through a private prescription as it would be cheaper,” he says. “It felt a little awkward for an NHS doctor to tell me not to go through the proper channels through a prescription and pharmacy, but it saved me a fair amount of money.” So, he bought the pills from an American website and gave them a try.

In the UK, Viagra can be given to anyone over the age of 18 to treat symptoms of erectile dysfunction, although it’s typically prescribed to those over 50. Yet recently, research has shown that there has been an increasing trend of younger men like Dan, who was 21 when he first tried Viagra, using the medication to enhance their sex lives.

While Dan says that Viagra is “useful for maintaining an erection”, it doesn’t actually make it easier to reach orgasm, which is a result of “a combination of physical and mental stimulation which Viagra doesn't necessarily [offer].” In fact, Dan’s experiences with Viagra were more bad than good. “On a couple of occasions I had a bad reaction to taking it, including once during sex,” he tells Dazed. “It gave me a flushed face, made me overheat and sweat more, raised my pulse to uncomfortable highs, and increased breathlessness.” On one occasion, he had to stop having sex because his chest began to hurt, leading him to think he was having a heart attack. “I was OK myself but the guy I was seeing freaked out and left, telling me that it wasn’t normal to be like that, which only added to the anxiety. I really don’t think I’d recommend it to [people] with mental health challenges.”

Research shows that impotence is on the rise globally. In fact, one study suggests that, by 25, some 322 million men will experience erectile dysfunction (ED), more than double the estimated 152 million who were impotent in 1995. And while ED is most common among older men, it appears to be increasingly impacting men under the age of 40, with one study suggesting around 26 percent of men in this cohort experiencing at least partial ED. There are several possible reasons for this: one is long-term computer use, which was linked to a rise in ED in a study of 200,000 men published earlier this year – and the overconsumption of pornography has often been associated with impotence – while other research has found that poor mental health, particularly stress, is a large factor in ED for young men.

However, while Dan and other young men dealing with erectile dysfunction use Viagra to help treat a medical problem, research suggests that Viagra is being used recreationally. Manchester-based Jeff*, 28, who asked to remain anonymous, has tried Viagra a handful of times, but isn’t much of a fan. The first time he used it was because he had been offered a pill from a colleague, and wanted to see what it was like. “The experience itself was a bit ‘meh’, because it’s not like I actually needed it,” he says. “I got a bit of a head rush and made sure I had lots of water to drink, but it didn’t enhance the experience.”

Some people, like Ali*, 24, from Manchester, use Viagra to help them maintain an erection after consuming drugs or alcohol, the effects of which often make doing so much more difficult. Ali, who also asked to remain anonymous, uses Viagra “once in a blue moon”, to help him keep it up after a night out. “It’s common knowledge that [ecstasy] pills make you soft,” he says. “I use it about 30 minutes before I know I’m going to have sex, and I find it’s really effective.” Ali, who bought the pills over the counter, hasn’t noticed any side effects, although he says it can be quite intense at first.

Jeff has also used Viagra to help keep an erection after using drugs. “This was better [than the other time] because my body actually needed it, but I’ve still only used it a handful of times because I don’t want the embarrassment of buying it from the shop and I don’t want to have to rely on it in the long-term.”

However, mixing Viagra with other recreational drugs can be dangerous. Harm reduction advocate and founder of Chemsex Harm Reduction Jona Tanguay explains that Viagra (sildenafil) and Cialis (tadalafil) are a class of drugs called phosphodiesterase-5 (PDE-5) inhibitors. Mixing them with drugs such as stimulants including MDMA and cocaine, as well as benzodiazepines and, vitally, poppers, which are used to enhance sex, can pose real risks.

“It’s really dangerous to put two drugs in your system that are complete opposites” – Paul North, harm reduction expert

“PDE-5 inhibitors interact with nitrites such as amyl nitrite, also known as poppers,” he tells Dazed. “When combined with nitrites [Viagra] can dangerously and acutely lower the blood pressure leading to fainting or even death.” The same goes for benzodiazepines like Valium or Xanax, which also lower your blood pressure. This is especially true for people with heart problems.

Stimulants, on the other hand, raise your blood pressure. “The way stimulants affect your blood vessels is the complete opposite of what Viagra does to them,” explains harm reduction expert and director of Volteface, Paul North.  “It’s really dangerous to put two drugs in your system that are complete opposites.” Not only can this lead to heart problems or a stroke, mixing Viagra and cocaine can cause priapism – a persistent and painful erection – which, left untreated, can cause erectile dysfunction.

Although you can purchase Viagra over the counter in the UK, some people still choose to buy it from the black market. One of the main risks involved with this is that you may end up purchasing fake Viagra, which could contain anything. Since 2014, only 20 samples of Viagra have been tested by the Welsh Emerging Drugs & Identification of Novel Substances (WEDINOS), which tests drug samples submitted by people from around the UK. While the majority of Viagra samples were accurate, meaning they contained sildenafil, some were completely missold. One sample came back as modafinil, a stimulant similar to Adderall, while another contained anabolic steroids – which are known to increase impotence. Other missold pills came back as etizolam (a benzo) and paracetamol. This is dangerous, especially when mixing with other substances, which could interact negatively.

While Jeff and Ali have managed to avoid experiencing any severe consequences from using Viagra, it’s important to remember that Viagra is a drug — and mixing it with things like poppers, heart or blood pressure medication and stimulants does carry risks. Still, there’s absolutely no shame in giving the little blue pill ago. As Ali says:  “I’m not ashamed of using it – it works.”