Brazil’s Military Reportedly Purchased Over 35,000 Viagra Pills, Raising Questions

This coming October, Brazil will be having a Presidential election. That’s election with an “l” and not an “r.” So critics of current Brazilian president, Jair Bolsonaro, have been wondering why the Brazilian military has reportedly purchased 35,320 pills of Viagra since 2020, according to a news report from Universo Online (UOL). You can imagine how such a large purchase would raise some questions, among other things. For example, UOL quoted Brazilian lawmaker Elias Vaz as stating, “We need to understand why the Bolsonaro government is spending public money to buy Viagra, and in such a high amount. The Armed Forces receive thousands of Viagra pills. Society deserves an explanation.” The Brazilian military apparently purchased sildenafil, which is the generic name for Viagra, in 25 mg and 50 mg doses via eight procurement processes since 2020.

Why are people standing up and questioning such a purchase? Well, sildenafil is best known as an erectile dysfunction (ED) medication. If you were to ask, “what’s ED,” and claim that you’ve never heard of or seen such a thing, here’s what ED is. It’s when a penis struggles to achieve and maintain an erection. The Mayo Clinic website indicates that recommended dose of sildenafil for the treatment of ED is 50 mg for adults under 65 years of age and 25 mg for those 65 years and older. Typically, you want to take the pill one hour prior to anticipated sexual intercourse, although you can stretch it out, so to speak, to 30 minutes to 4 hours before doing the deed. Before you take a pill, make sure that intercourse is really going to happen. Sildenafil isn’t the type of thing that you should take with no real plan in place, simply because today just might be the day.

That being said, it’s hard to see why the military would need so many sildenafil doses. According to UOL, Brazil’s Navy and Army justified the purchases by saying that the medication can be used to treat pulmonary arterial hypertension (PAH). PAH is certainly a stiff problem in a different way. It is when there’s elevation in the pressure in the arteries that bring blood from your heart to your lungs. Over time, this condition can “cause the walls of the arteries to become stiff, swollen and thick,” in the words of the Mayo Clinic website. As a result. the right side of your heart has to work harder to pump blood through these arteries and eventually begins to malfunction. Chronic PAH is a very serious condition and can very readily lead to an early death. There are a number of possible causes of PAH, ranging from high altitude to congenital heart defects to drug or toxin exposure to connective tissue disorders to infections with HIV or schistosomiasis.

Doctors have indeed been using sildenafil in some cases to treat PAH. That’s because sildenafil can inhibit the phosphodiesterase enzymes in blood vessel walls, causing the blood vessels to relax and widen, as I described last week for Forbes. That can get more blood flowing into your penis and through your pulmonary arteries, two parts of your body that you probably don’t tend to mention together. Here’s a Mayo Clinic video covering the use of such ED medications to treat PAH:

Studies have suggested that sildenafil can help alleviate high altitude-induced PAH as well.

Before you start popping Viagra to keep your pulmonary arteries from getting “stiff, swollen, and thick,” though, keep in mind that “PAH is a rare disorder found in 15 to 50 persons per million within the United States and Europe,” in the words of Deborah Jo Levine, MD, FCCP writing for the American Journal of Managed Care (AJMC). Therefore, there probably isn’t a large number of Brazilian military members suffering from chronic PAH. Even if you were to argue that the sildenafil was to help alleviate temporary high-altitude-induced PAH, it’s not as if most of the sildenafil went to military members likely to operate in high altitudes. According to the UOL article, 28,320 pills went to the Navy, which meant that a lot of the sildenafil may have gone to seamen. Presumably many Navy members work at sea level. And sea level tends to be at, you know, sea level and not on top of mountains. By comparison, the Army and the Air Force seem to be getting the short end of the purchases with each receiving only about two thousand pills.

Plus, the 25 mg and 50 mg doses purchased by the Brazilian military seem a bit, shall we say, big for PAH purposes. Take a look at what the Mayo Clinic recommended for treating adults with PAH: 5 mg or 20 mg of sildenafil three times a day for adults with each dose spaced about four to six hours apart. Something that’s five or 20 is not 25 or 50, regardless of what angle you look at it or what the lighting may be.

It remains to be seen what other explanations for the sildenafil purchases will emerge. Will Bolsonaro’s administration be able to provide an important rather than an impotent reason? Will there be enough justification for this to be a standing order? Or will this be considered a case of erection fraud?