Unspoken Side Effects of Sedatives in Surgery: Patients Reporting Sexual Hallucinations
Vivid, sometimes troubling sexual fantasies have surfaced during surgery among some patients under anesthesia, according to a growing body of research. These are not fleeting daydreams, but lucid, detailed hallucinations that sometimes blur the line between reality and delusion, leaving patients confused, distressed, and in some instances embroiled in legal repercussions.
Anesthetic drugs like benzodiazepines (such as midazolam and diazepam) and propofol, as well as ketamine and nitrous oxide, have been found to trigger sexual hallucinations in certain doses. These drugs influence the activity of neurotransmitters in the brain, slowing brain activity and inducing relaxation, but excessive concentrations seem to open a surprising door to the subconscious mind, revealing repressed emotions or thoughts in exaggerated or distorted forms.
A recent report in Psychology Today referenced 87 published cases of drug-induced sexual hallucinations, with about 41% involving midazolam or diazepam. Patients shared tales of fleeting sexual dreams to distressing hallucinations of assault.
In one study of 110 dental surgery patients, 13.6% reported experiencing sexual arousal, dreams, or hallucinations during or after anesthesia, mostly describing them as dreams. However, 10% recounted sexual visions that were unpleasant and persisted into recovery.
Interestingly, the sex of the medical team appeared to play a role. Among approximately 300 male patients undergoing urological surgery, none reported sexual dreams when the team was all male. However, at least one patient experienced them when a female anesthesiologist was present, and declined to elaborate.
Similarly, women reported such episodes differently. In a group of 130 female patients sedated with propofol and alfentanil, 12% displayed amorous or disinhibited behavior. Some patients later described these episodes as hallucinations, whereas others remembered feelings of exposure or vulnerability.
In a 1990 study, researchers documented 41 incidents of women experiencing fantasies during sedation with intravenous midazolam or diazepam, 27 of which involved a sexual element, and 20 were described as unpleasant. Events unfolded in a logical sequence, and patients recalled them with an eerie certainty.
However, independent witnesses confirmed that many of the reported incidents did not occur. In some instances, patients' recalled experiences mirrored actual procedures or gestures, but with altered interpretations, such as reimagining surgical swabs as inappropriate touching.
Such hallucinations have given rise to legal complaints against healthcare providers, who were later found to be innocent. The study recommended that "lady patients" should not be examined or treated without the presence of a responsible third person during or following sedation.
Researchers propose that the pharmacological effects of anesthetics on neurotransmitters like GABA and dopamine are responsible for these hallucinations. High doses of these drugs may disrupt certain brain regions, allowing suppressed thoughts or emotions to surface in amplified or distorted forms.
Notably, men were more likely to report fantasies and found them generally pleasurable. Women, on the other hand, more frequently reported hallucinations resembling assault and found them more disturbing.
For healthcare professionals, these findings have both clinical and ethical implications. Given the vivid and potentially traumatizing nature of these hallucinations, health care providers are encouraged to acknowledge patients' experiences and inform them about the potential risks, especially when high-dose sedatives are used. Protective measures like having a witness or using video monitoring during sensitive procedures should also be considered.
Even if the events never actually occurred, the emotional repercussions can be severe. After a routine procedure, one woman described an overwhelming urge to reveal a private tattoo to the medical team. Although no one had touched her inappropriately, the feeling of violation lingered.
While these drugs have made invasive procedures less painful and more bearable for many, it's important to remember that they don't just quiet the mind—they can occasionally detach it as well. As a result, clinicians must be mindful of the effects drugs can have on patients' perceptions and emotions, and take steps to ensure safety and minimize potential harm.
- Researchers suggest that high doses of anesthetics, such as GABA and dopamine affecting drugs, can disrupt certain brain regions, allowing suppressed thoughts or emotions to surface in amplified or distorted forms, leading to vivid hallucinations.
- The study found that women were more likely to report hallucinations resembling assault and found them more disturbing, while men were more likely to report fantasies and found them generally pleasurable.
- Healthcare professionals are encouraged to acknowledge patients' experiences and inform them about the potential risks, especially when high-dose sedatives are used, to minimize the potential trauma associated with these hallucinations.
- Clinicians must be mindful of the effects drugs can have on patients' perceptions and emotions, and take steps to ensure safety and minimize potential harm during invasive procedures, even if the events never actually occurred.
