Can Anesthesia Cause Involuntary Erections?

The 2025 EAU Guidelines on Sexual and Reproductive Health acknowledge that intraoperative erections can occur during urological procedures, though they do not specifically classify this as a common or expected side effect of anesthesia itself¹. When such events occur, they may require management to allow the surgical procedure to continue without complications. The guidelines mention that certain pharmacological interventions have been studied for the prevention and management of intraoperative erections². 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. These implants are typically considered third-line treatments for erectile dysfunction when other approaches have failed. 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. For patients undergoing urological procedures where unwanted erections might complicate surgery, the guidelines reference studies on pharmacological management. For example, one study mentioned in the guidelines examined the use of ketoconazole as a preventive measure for postoperative penile erections⁷. Additionally, for patients experiencing prolonged erections after intracavernous injections of vasoactive medications, various interventions, including terbutaline, have been studied⁸. The guidelines also address concerns related to penile size and augmentation procedures. This highlights the importance of evidence-based approaches to penile interventions and the need for proper patient counseling regarding realistic expectations. For patients experiencing priapism (persistent or prolonged erection in the absence of sexual stimulation), the guidelines provide detailed management protocols. In cases where priapism has been present for more than 48 hours, the guidelines suggest considering primary 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 as a common occurrence or concern, they do provide comprehensive information on the physiology of erections, 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.