Understanding Sexual Hallucinations During Anesthesia
Some patients may experience vivid and detailed sexual hallucinations while under anesthesia with sedative-hypnotic drugs such as propofol, midazolam, diazepam, and nitrous oxide. These hallucinations can range from making suggestive or sexual comments to acting out inappropriately, such as grabbing or kissing medical professionals or engaging in sexual touching. Others may wake up mistakenly believing they were sexually assaulted. But why does this happen?
The Influence of Sedative-Hypnotic Drugs
Medical professionals have long known that sedative-hypnotic drugs, which slow down brain activity to induce calm or sleep, can affect a patient’s perception of reality. A review conducted in 1984 on drugs like midazolam, ketamine, and thiopental found that 18% of patients receiving anesthesia experienced difficulty distinguishing reality from fantasy during and after the procedure. Similarly, a study in 1980 revealed that around 14% of patients reported sexual dreaming or arousal while under anesthesia. It’s not surprising that the combination of these effects could lead to sexual hallucinations.
Instances of Sexual Assault
Although rare, there have been cases where medical professionals have taken advantage of a patient’s unconscious state to commit sexual assault. One such case occurred in 1991 when a health professional sexually assaulted a university student who was under anesthesia. Initially, the case was dismissed based on the possibility of drug-induced sexual hallucination. However, genetic evidence left by the health professional eventually led to his conviction. It is important not to assume that every reported sexual assault under anesthesia is related to a hallucination.
Researching Sexual Assault and Sexual Fantasy during Anesthesia
We are pharmacology researchers who conducted a thorough analysis of the medical literature on sexual assault and sexual fantasy during anesthesia. Our review spanned from the earliest documented case to February 2023 and included 17 published papers, identifying a total of 87 reported cases. Understanding the triggers for unpleasant or sexual dreams during anesthesia could lead to measures that reduce the risk of hallucinations, promoting both patient and provider safety.
Reports of Sexual Hallucinations
Out of the individual cases we reviewed, 16 involved patients reporting sexually amorous behavior or perceived sexual assault. In these instances, there were witnesses present, such as health professionals or family members, which reduces the likelihood of the behavior being real rather than hallucinated.
We also noticed a significant correlation between the location of the procedure and the area where the patient perceived inappropriate sexual contact. For example, procedures involving the mouth were perceived as oral sex, while chest procedures were interpreted as breast fondling. This observation may explain why a study on 200 patients undergoing gallbladder or appendix procedures found no cases of sexual hallucination, while around 12% of those undergoing vaginal procedures reported amorous or sexually disinhibited behavior.
Trauma for Patients and Providers
The effects of anesthesia-induced sexual hallucinations can have lasting impacts on both patients and providers. Patients who experience these hallucinations undergo emotional turmoil, whether or not they believe the assault to be real. Furthermore, medical professionals accused of sexual assault, even if it is based on a hallucination, can face regulatory actions or legal consequences, including losing their license to practice.
Informing patients about the possibility of sexual hallucination as a rare but potential side effect of anesthesia, as well as explaining the steps being taken by medical providers to reduce this risk, could help patients differentiate between hallucinations and reality. However, this does not diminish the trauma associated with these hallucinations. Withdrawal from a study was observed in one case, where an anesthesiology student experienced sexual hallucinations after taking sedative-hypnotics. Despite knowing that the memories were not real, the distress was significant.
We discovered 71 individual cases in our literature review where the medical professional was alone with the patient during the alleged sexual assault or behavior. To ensure the safety and well-being of both patients and medical professionals, having witnesses in the room or utilizing recording devices during dental or medical procedures could help prevent opportunities for sexual assault and reassure patients that any hallucinations they experience are not real.
However, the healthcare system must take further steps to protect patients. Those who struggle with the trauma of hallucinated sexual assault, even if there is evidence that it never occurred, should be referred to counseling and provided with support, as one would for someone who experienced physical harm during a medical or dental procedure.
Unanswered Questions and Areas for Further Research
It remains unclear why certain individuals are more likely to remember their dreams while under anesthesia. A study conducted in 2009 on 97 patients receiving propofol revealed that those who frequently remembered their dreams after anesthesia received higher doses, were younger than 50 years old, and took longer to recover. A 2013 study on 200 patients also receiving propofol found that men were more likely to remember their dreams, while women were more likely to remember unpleasant ones. Although dreams and hallucinations are related experiences, individuals experiencing hallucinations are more likely to believe they are real.
Despite reviewing all published cases of sexual hallucinations in the medical literature, the true incidence of anesthesia-induced sexual hallucinations remains unknown. Further research is necessary, considering the decades that have passed since the first reported cases. To determine the prevalence of sexual hallucinations, data from a large sample size will be required. However, drug companies are often reluctant to invest in research that may reveal adverse side effects of their drugs.
Looking Beyond Anesthesia
While our review focused on sexual hallucinations during anesthesia, it’s important to note that millions of Americans use other prescription sedative-hypnotic drugs. Benzodiazepines, Z-drugs, opioids, gabapentinoids, and muscle relaxers have all been associated with hallucinations in some cases. A review of the FDA Adverse Events Reporting System found over 30,000 cases of “abnormal dreaming” related to these drugs, with the majority used to treat insomnia, anxiety, pain, and muscle spasms. However, the specific nature of these dreams and their impact on patients’ well-being was not specified.
Patients should be aware that abnormal dreaming is a possibility when starting a sedative-hypnotic medication. It is crucial to inform healthcare providers if hallucinations are experienced, as it could indicate that the current medication is not suitable or that the dosage is too high.
This article was republished from The Conversation under a Creative Commons license. Read the original article here.
