While celebrities from Michael Douglas to Hugh Hefner have gone public to sing the praises of sex drugs such as Cialis and Viagra, the use of erectile dysfunction (ED) medication remains largely a global taboo.
Even in a country like Sweden, which has a reputation for being more sexually liberal than many other nations, studies suggest that around nine out of ten men with ED never seek treatment. Others resort to using unregulated illegal websites.
But a new way of buying legal, performance-enhancing drugs online is helping men aged between 18 and 80 to improve their sex lives, according to the team behind Potensify, a startup based in Lund in southern Sweden.
"Many men find it awkward and embarrassing to seek help for these kind of symptoms," co-founder Philip Segenmark tells The Local.
He joined forces with trained general practitioner Richard Ljungberg to launch the service last year and is currently working on an English-language version of the site.
"We want to destigmatize the problem, we want to educate and we want to treat," he says.
Potensify's co-founder Philip Segenmark. Photo: Potensify
Potensify allows patients to go online to do the same medical questionaire they're usually required to complete in person at their doctor's surgery. Their identity is checked using BankID, a popular app in Sweden that allows people to shop online securely by linking their social security, bank account and mobile phone numbers.
The service costs 300 kronor, the same as a regular appointment ($35) at a state-subsidised Swedish clinic. If Dr Ljungberg agrees that a patient should be given a drug prescription, this is automatically put into the nation's electronic prescription database and and can be picked up from any pharmacy.
"About six months ago I met a new woman and we decided to get together. It was working now-and-then, but not all of the time," says one 67-year-old customer from Malmö who has asked to be known simply as Bengt.
After spotting an article about Potensify in a Swedish tabloid last year, he decided to give the newly-launched startup a go in order to seek drugs to improve his performance with his 60-year-old Danish partner.
"Now we can have an absolutely enormous sex life (...) We have sex about three or four times a week! She is just as happy as I am!" he tells The Local, with a chuckle.
"For me, it is just very convenient to use Potensify because I can just go to the computer and I can get the drugs in a very short time – it's very easy."
A screen shot of the survey Potensify customers fill out. Image: Potensify
Recent research suggests people in Sweden are staying sexually active for much longer than in the past, with one study by Sahlgrenska University Hospital in Gothenburg reporting that 34 percent of women and 66 percent of men in their seventies still enjoy intimate relationships.
However Segenmark says that neither Swedes' reputation for getting naked in their autumn years nor the stereotype of a nation of shy residents uncomfortable with talking to one another played a factor in his decision to launch the company on home soil.
Instead, he argues that Sweden's position "at the forefront of digitalizing systems" helped provide the ideal climate and market in which to launch Potensify, although he hopes that the model can be transported to other countries.
"Without advertising we are already getting a lot of interest from potential customers in Germany (...) so we are looking at how the site can develop in countries without BankID. BankID is only in Sweden and in Norway. We are talking to Norway but it can take between three and 30 years to get things done there!"
In the meantime, Potensify says its next focus will be on delivering the English-language version of the site, so that Sweden's international community can also secure access to its services. Around 30 percent of men in their thirties living in the Nordic nation are believed to suffer from sexual dysfunction, rising to 50 percent of over-50s.
Richard Ljungberg is the company's doctor and co-founder. Photo: Potensify
Segenmark and Ljungberg's company has already generated a buzz in Sweden's tech and business media, but the startup's innovative model has faced some strong criticism from within the Nordic health sector.
"Patients will get a much more thorough check-up if they come into the regular healthcare system," Emma Spak, a spokesperson for the Swedish Medical Association on e-health, pharmaceuticals and medical technologies, tells The Local.
"I personally would be reluctant to prescribe medication in this way, it seems rather rudimentary. Doctors don't just stick to a script, we also do blood or maybe glucose tests before we prescribe drugs like Viagra and we have access to patient's full medical history. So anyone starting a business in this way needs to take full responsibility [for working without this information]."
She says she is personally "very disappointed" that Swedes are drawn to new online services like Potensify.
"It's a sad thing if the solution to the embarrassment is that we are driving people online and then they are just becoming more and more anonymous."
However Segenmark is quick to respond to such criticisms, noting that Potensify customers are still advised to seek medical checkups in person and insisting that the site remains a much safer option for patients who have previously used illegal websites to order drugs.
"Research by the drug company Pfizer suggests that three percent of Swedes are self-medicating – which can be dangerous – you don't have any proof of who you are buying from," he adds.
The entrepreneur says that the daily feedback he gets from customers keeps him confident that his company will win people over. This includes emails ranging from 45-year-olds who have just identified potential problems with their sexual health, to others sharing how they stayed silent for more than a decade before testing out ED drugs using Potensify.
"It has saved people's lives – men who have been embarrassed to talk about their problems and their wives who thought that they weren't sexually attractive any more – things are different for them now."