Can Anesthesia Cause Involuntary Erections?

Erections can occasionally occur during urological procedures, but the 2025 EAU Guidelines on Sexual and Reproductive Health do not address erections during surgery or anesthesia¹. When such events occur, they may require management to allow the surgical procedure to continue without complications. The guidelines discuss medicines used to treat and prevent priapism (prolonged, unwanted erections), but not erections that occur during surgery². For patients concerned about penile implants and erectile function, the EAU Guidelines provide comprehensive information about available treatment options. The two main classes of penile implants currently available include inflatable (two- and three-piece) and semi-rigid devices³. Under the EAU Guidelines, they may be considered for men who are not suitable for other drug treatments or prefer a definitive therapy, and who do not respond to other treatments. According to the guidelines, there is sufficient evidence to recommend these devices for patients with refractory erectile dysfunction, with high rates of satisfaction reported by both patients and their partners after penile implant surgery⁴. The guidelines note that there is no significant difference in terms of efficacy and safety among the different penile implants available on the market⁵. However, patients may prefer the three-piece inflatable devices due to the more natural erections obtained, though these devices require greater manual dexterity to operate⁶. Semi-rigid implants may be more appropriate for patients with limited manual dexterity, though they offer less concealability when not in use. The guidelines do not discuss unwanted erections during urological surgery, but they do review medicines for preventing recurrent priapism (repeated, prolonged erections). For example, the guidelines mention ketoconazole, a drug that lowers androgen levels, as one option for preventing recurrent (stuttering) priapism, citing a study that tested it to prevent erections after surgery⁷. Additionally, for patients experiencing prolonged erections after intracavernous injections of vasoactive medications, various interventions, including terbutaline, have been studied⁸. For patients experiencing priapism (persistent or prolonged erection in the absence of sexual stimulation), the guidelines provide detailed management protocols. In cases where ischemic priapism has been present for more than 48 hours, the guidelines suggest discussing immediate penile implantation¹⁰. This recommendation underscores the importance of timely intervention for prolonged erections to prevent long-term erectile dysfunction. While the guidelines do not specifically address spontaneous erections under anesthesia, they do provide comprehensive information on the causes of erectile problems, factors that can affect erectile function, and management strategies for various erectile disorders. Patients concerned about this potential occurrence should discuss their concerns with their healthcare provider prior to any surgical procedure.