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 recognize three main types of penile implants: malleable (semi-rigid), two-piece inflatable, and three-piece inflatable prostheses.² Each type offers different mechanical properties and patient experiences, with the three-piece inflatable devices providing the most natural flaccid and erect states according to patient satisfaction studies.³

During penile implant surgery, which is performed under anesthesia, the patient’s natural erectile tissue is partially removed to create space for the implant cylinders. The EAU Guidelines report high satisfaction rates for penile implants, with studies showing 92-100% of patients and 91-95% of partners reporting satisfaction with the functional and aesthetic outcomes.⁴ This high satisfaction rate is attributed to the reliable mechanical function of modern implants, with 5-year device survival rates exceeding 90% for most current models.⁵

Regarding penile size considerations, the EAU Guidelines acknowledge that some patients may have concerns about penile dimensions. The guidelines provide specific measurement protocols for assessing penile length and girth, noting that “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 psychological counseling rather than surgical intervention in most cases, as many patients overestimate what constitutes “normal” penile dimensions.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. In fact, the guidelines explicitly 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 While the guidelines do not specifically discuss erections under anesthesia, the detailed protocols for implant surgery reflect the understanding that the surgical environment, including anesthesia, creates controlled conditions where natural erectile function is temporarily suspended to facilitate the procedure.