Do guys get hard under anesthesia?

The 2025 EAU Guidelines on Sexual and Reproductive Health do not specifically address spontaneous erections under anesthesia, as this is not a primary focus of the guidelines. However, the guidelines extensively cover penile implants as a treatment option for erectile dysfunction, which provides relevant context for understanding penile function in surgical settings.¹

Penile implants, as detailed in the EAU Guidelines, are surgical devices placed within the penis to enable men with erectile dysfunction to achieve an erection. The guidelines describe two main classes of penile implants: inflatable (two-piece and three-piece) and semi-rigid (malleable) prostheses.² Each type offers different mechanical properties and patient experiences; patients may prefer three-piece inflatable devices because they give more natural erections, although no prospective randomized trials have compared satisfaction between implant types.³

During penile implant surgery, which is performed under anesthesia, the erectile tissue inside the penis is stretched (dilated) to create space for the implant cylinders. The EAU Guidelines report high satisfaction rates for penile implants, with 92-100% of patients and 91-95% of partners satisfied when appropriate counseling is provided.⁴ Technical improvements have reduced mechanical failure rates of the most commonly used three-piece implants to below 5% after five years, although a meta-analysis found overall implant survival of about 87% at five years.⁵

Regarding penile size considerations, the EAU Guidelines acknowledge that some patients may have concerns about penile dimensions. The guidelines provide recommendations for measuring penile length and girth, noting that “the measurement of penile size has not been standardised and to date there is no consensus definition due to high heterogeneity in terms of data assessment and reporting methodologies amongst different studies.”⁶ For patients with concerns about penile size, the guidelines recommend a psychosexual assessment, with psychotherapy when body dysmorphic disorder or other psychological problems are suspected.⁷

For patients undergoing penile implant surgery, the EAU Guidelines emphasize the importance of realistic expectations. While implants restore erectile function, they do not increase penile length beyond the patient’s natural erect length. Separately, in their chapter on penile size, the guidelines state that “testosterone therapy does not increase penile size in adult men and in men with late-onset hypogonadism”⁸ and strongly recommend against using “testosterone therapy or other hormonal therapies to increase penile size in men after puberty.”⁹ This underscores the importance of proper patient counseling before implant surgery to ensure satisfaction with outcomes.

The guidelines also address specific surgical considerations for penile implants, including approaches (infrapubic vs. penoscrotal), antibiotic prophylaxis to prevent infection, and special considerations for patients with Peyronie’s disease or priapism.¹⁰ The guidelines do not specifically discuss erections under anesthesia.