Under the haze of anesthesia, some patients undergoing surgery experience something you wouldn’t expect in this tense setting — vivid, sometimes disturbing sexual fantasies. In rare but striking cases, these dreams and hallucinations have blurred the lines between reality and delusion, leaving behind confusion, distress, and in some instances, legal fallout.

A growing body of literature is shedding light on an unsettling phenomenon: certain sedative and hypnotic drugs, especially those used in anesthesia, can provoke sexual hallucinations. These are not idle daydreams. They unfold with startling clarity, often in a logical sequence, and some patients recall them with an eerie sense of certainty.

A Hidden Side Effect

The sedatives most commonly linked to these hallucinations include benzodiazepines like midazolam and diazepam, as well as propofol, ketamine, nitrous oxide, and even older agents like ether and chloroform. Most of these drugs act on GABA, a neurotransmitter that slows brain activity and induces relaxation — but in certain doses, they seem to open a peculiar erotic window into the subconscious.

A recent blog post published in Psychology Today described 87 published cases of drug-induced sexual hallucinations. About 41% involved midazolam or diazepam, often at high doses. Patients have recounted everything from fleeting sexual dreams to distressing hallucinations of assault.

In one study of 110 dental surgery patients, 13.6% reported experiencing sexual arousal, dreams, or hallucinations during or after anesthesia. Most described them as dreams. But 10 percent reported sexual visions that were unpleasant and lingered into recovery.

The sex of the medical team appeared to matter. In a report of roughly 300 male patients undergoing urological surgery, none reported sexual dreams when the team was all male. But when a female anesthesiologist was present, at least one patient did — and declined to elaborate.

Women also reported these episodes, though differently. In a group of 130 female patients sedated with propofol and alfentanil, 12% showed amorous or disinhibited behaviors. Some patients later described these episodes as hallucinations. Others simply remembered feelings of exposure or vulnerability.

Real Feelings, Imagined Events

A study from 1990 documented 41 incidents of women experiencing fantasies during sedation with intravenous midazolam or diazepam. Twenty-seven involved a sexual element, and twenty were described as unpleasant. These were not vague impressions. The events “occurred in a logical sequence and all were certain of their authenticity,” the study reported.

But here lies the disquieting twist: of 25 verified patient reports regarding occurrences during sedation, 17 turned out not to have occurred. In some of the remaining cases, the fantasies mirrored actual procedures or gestures, but with altered meanings. For instance, the pressure of a surgical swab might be reimagined as inappropriate touching.

“The events felt real,” noted one researcher, “but independent witnesses confirmed they did not happen.”

Such hallucinations have spurred legal complaints, often against health care providers who were later found to have done nothing wrong. The study concluded that “during or following sedation, lady patients should not be treated or examined without the presence of a responsible third person.”

The question remains: why do some people experience these fantasies under sedation?

Their Chemical Romance

Researchers point to the drugs’ actions on neurotransmitters like GABA and dopamine. Benzodiazepines and propofol, for example, enhance GABA’s calming effects. But in high doses, these effects may disinhibit certain brain regions — allowing suppressed thoughts or emotions to surface in exaggerated or distorted forms.

Some dopamine-enhancing drugs, such as those used for Parkinson’s disease or ADHD, have also triggered libido surges or sexual fantasies. Antipsychotics and antidepressants — especially those altering dopamine pathways — have been implicated too.

Ketamine, a dissociative anesthetic now also used in depression treatment, has caused some patients to experience graphic or distressing sexual visions. “One patient stated she would not undergo anesthesia again if ketamine was used,” a review found. During the Vietnam War, soldiers sedated with ketamine sometimes emerged with hallucinations of sexual assault — a phenomenon known as emergent psychosis.

Importantly, men were more likely to report fantasies, and often found them pleasurable. Women, however, reported more hallucinations resembling assault, and were more likely to find them disturbing.

Calling Saul

For health care professionals, these findings carry both clinical and ethical implications. The hallucinations, while rare, are vivid and potentially traumatizing. Some patients, believing the visions were real, have discontinued care or filed complaints.

“Although such sexual hallucinations and fantasies are rare, the vivid recollection of the patient’s experiences should be recognized and acknowledged,” the review warned.

Experts now recommend that clinicians inform patients — especially those receiving high-dose sedatives — that such hallucinations are possible. They also urge protective protocols, like ensuring a witness is present, or using video monitoring, particularly during sensitive procedures.

Even if the events never happened, the emotional scars can be real.

One woman, after receiving sufentanil, propofol, and midazolam for a routine procedure, described a compelling urge to show the medical team a private tattoo — a hallucination she later found deeply distressing. Though no one had touched her inappropriately, the sense of violation lingered.

As powerful as they are, sedatives don’t just quiet the mind — they sometimes unmoor it.

For decades, these drugs have made invasive procedures less painful and more bearable. Midazolam and diazepam, in particular, are considered among the safest short-term sedatives in medicine. But safety isn’t everything.

What happens under sedation may stay in the mind long after the drugs have worn off.

“Some events,” as the 1990 paper put it, “are very real to the patient — and yet, on the evidence of two or more independent witnesses, did not occur.”

That contradiction makes these hallucinations especially thorny (I said thorny). The memories may be false, but the emotions they carry are not. And in medicine, that distinction matters.