Three men in their mid-fifties sit on stools outside a dim hole-in-the-wall bar near O’Russey Market. They wish themselves good health, clinking glasses that are filled with a dark reddish-brownish liquid from one of the four gigantic smudgy jars that stand in the entrance.

The fluid is widely believed to cure sexual dysfunction and boost stamina in men – one of a huge variety available over the counter in local pharmacies and even on supermarket shelves.

“In four out of ten beer gardens you can order a bull penis,” claims Touch Makara, who sells the drink.

“You wouldn’t order that when you are there with your girlfriend. It would embarrass her because everybody walking past would think you two will have sex tonight.”

The more innocuous red fluid tastes bitter, and strongly medicinal. I feel tipsy, but not extra virile. Made from herbs and bark and pickled in rice wine, the drink comes from a traditional Khmer pharmacy just 100 metres from the bar.

“Men often have it [the tonic] with food in bars that specialise in brewing it because it is less obvious then,” says Srey Teurn, the 43-year-old owner.

“Men who use my medicine don’t buy it here themselves. They are too shy.”

Even though Cambodians are very discreet about sex, and even more so about sexual dysfunction, there is a big market for aphrodisiacs and medication that treats problems, especially for men.

“The market for sex products is very big,” says Dr. Hieng Punly, chief advisor of the Angkor Centre for Research and Development of Herbal Medicine Organisation (ACReDoHM).

Most consumers are men older than 40, he adds.

In his office on a dusty road in Khan Meanchey, in the outskirts of Phnom Penh, he sits next to Dr. Pen Sunna, the organization’s CEO and retired head of the National Centre of Traditional Medicine, part of the Cambodian Ministry Of Health.

I show them both samples of sexual performance enhancing products I have bought from pharmacies, markets, and supermarkets.

First off, Black King, a pill from China. On the package a mighty black gorilla poses with a lady wearing a red cocktail dress. On the insert are a pornographic scene and the hint that the products beneficial effects (“increased semen”, “tone up kidney”, “rigidity for a long time”).

After popping the pill, I get a terrible headache and acid reflux.

“You have to be careful with products that are not approved. They can contain plants but also dangerous chemicals,” Punly explains.

The money to be made in the market for aphrodisiacs, he says, can lead companies to produce counterfeit products with a variety of chemicals.

While all three of us agree that Black King is useless if not dangerous, I want to know: do the natural alternatives actually do anything?

“Sometimes you cannot explain practical knowledge that has been passed down from generation to generation. Men say the products work but we haven’t found out why yet,” says Punly.

You have to be a believing Buddhist if you want natural medicine to work, he adds.

According to Buddhist beliefs, Punly says, all matter can be assorted to one of the four elements of, earth, water, wind, and fire: these things are visible and can be explained. Then there is the spirit in things, which is invisible and inexplicable but still there.

“Sexual dysfunction needs fire. Dog and snake meat warm up the body and all sorts of animal penises: penises of hogs, goats, bulls, and buffalos,” he says.

Some old recipes that have been passed down for generations include illegal and questionable ingredients – such as rare animal parts, especially the horns of rhinos.

“Something in rhinos’ diet makes them produce a special hormone or other active ingredient that can boost sexual power. It is not studied enough yet but I believe it is true,” Punly says, adding that he doesn’t advocate rhino poaching for medicine.

“Most educated men who have heard about Viagra will ask for Viagra in a modern pharmacy and not use traditional products,” Sunna says.

It’s not just products. Acupuncture needles are supposed to manipulate the body in away that erections become possible again.

From a pharmacist I hear of a practitioner near Monivong Bridge who treats sexual problems by inserting a hooked needle into an acupuncture point on the perineum (the area between anus and testicles) and cuts it off, leaving the hook under the skin.

The pharmacist calls the acupuncturist and asks if it would be possible for he and I to visit. The acupuncturist doesn’t wish to speak to the press.

I visit his practice anyway. A fine layer of brown dust from the outside road seems to cover everything inside the business, which sells many Chinese herbal products (among them Black King which I buy there). I tell the young man behind the counter that I would like to speak to the specialist and am told he is out of the country - and no, he doesn’t know when he will be back.

Treating sexual dysfunction or under-performance with acupuncture is common, says Japanese acupuncturist Takada Tadanori.

“I treat many cases like that (sexual dysfunction especially caused by stress and fears). It is also good for stressed women, not only men.”

Tadanori works for the Nippon Foundation, a Japanese NGO collaborating with Cambodia’s National Centre of Traditional Medicine (NCTM) to establish standards for traditional medicine - including acupuncture, which is not regulated, NCTM director Mao Soklim tells me.

Tadanori has heard of the technique of the hooked needle left under the skin of the perineum and points out this particular acupuncture point on a chart. The treatment isn’t safe and isn’t one he would ever carry out on a patient.

“The technique of cutting off the needle is illegal in Japan and you don’t need to be a doctor to know that it is really dangerous to have a needle hook under the skin down there,” he says.

Tadanori says the hook could wander under the skin and cause infections.   

“I would never use that acupuncture point for anything if I didn’t have to. It’s too delicate there.”

He treats sexual problems in his patients by targeting the acupuncture points located on the back. “You can make sexual performance stronger with acupuncture,” he says. “But not much.”

In front of the dingy bar near O’Russey Market the three men that clink glasses with bitter brown medicine to improve the blood circulation are quite drunk.

“If you drink too much the good effects of the medicine don’t work.” Kiri keeps on repeating, clearly missing out on the good effects already. He seems happy anyway.

For all the stuff I tried I can say for myself that it didn’t work - at least not in the intended way. All I got was heartburn, headache, and a blood rush to the head. But like Punley says, you have to believe in the inexplicable if your love drugs of choice are to work in the way you want.

And don’t scientists say the greatest erogenous zone in the body is the brain?”

Additional reporting by Khouth Sophak Chakrya