Several Sedative Drugs May Give You Sexual Fantasies
Sedative hypnotics were most often associated with sexual hallucinations.
Posted May 6, 2025 | Reviewed by Hara Estroff Marano
A recent review of the literature found ample evidence that some sedative hypnotic drugs can cause vivid sexual hallucinations. The analysis discovered that sexual fantasies are most often associated with the use of benzodiazepines, propofol, nitric oxide, ether, chloroform, and ketamine . Health care professionals need to be aware of the potential risks to the patient and legal risks for themselves.
Out of 87 cases published, 41 percent of the reported sexual fantasies were associated with the benzodiazepines midazolam (a premedication before surgical anesthesia) and diazepam. Dose played an important role. Sexual hallucinations occurred only when the doses of midazolam or diazepam administered were rather high. Propofol produced sexual hallucinations in two studies when doses greater than 30 mg or 2 mg/kg were administered.
Sexual hallucinations, or sexual fantasies, have also been reported after administration of surgical anesthesia. In one study, 110 dental surgery patients (or about 13.6% of the total number included in the study) reported episodes of sexual dreaming , hallucinations, and/or sexual arousal after being administered a standard cocktail that included fentanyl, diazepam, and methohexital. The nature of the sexual episode varied. Sixty percent reported some form of sexual dream during the surgery, while 13.3% had sexual dreams after they returned home. About 10 percent of patients reported experiencing unpleasant sexual hallucinations while in the recovery room.
The impact of the sex of the patient and therapist.
In a report of approximately 300 predominantly male patients undergoing a urological procedure, none of them reported having a sexually related dream when the surgical team was all male. However, 40 male patients had a female anesthesiologist and one of them reported having a dream about her during anesthesia but was unwilling to elaborate on the nature of the dream. Twelve percent of 130 female patients undergoing propofol and alfentanil anesthesia for dilation and curettage, cystoscopy, or cervical biopsy reported experiencing amorous or disinhibited behaviors while sedated.
Benzodiazepines and propofol were not the only drugs that produced sexual fantasies. Dopamine agonists, such as ADHD medications and stimulants, dopamine antagonists, such as antipsychotics , and some antidepressants have also produced sexual fantasies in some patients. Dopamine-enhancing anti-Parkinson medications have been known to have a libido-stimulating effect in males.
Patients given ketamine reported having dreams that were unpleasant due to images of sexual assault ; one patient stated she would not undergo anesthesia again if ketamine was used. Similar unpleasant experiences, called emergent psychoses, were reported by soldiers given ketamine for surgical procedures during the Vietnam conflict.
Overall, women were more likely to report sexual assaults during their drug-induced hallucinations. Men reported having more drug-induced sexual fantasies (up to 63%) than women. Men also reported that their hallucinations were pleasant more often than the women reported; for this reason, males complained about their drug-induced fantasies less often.
Some caution is necessary when interpreting the results of studies that depend entirely upon patient recall of drug-induced memories. Also, due to the polypharmacy involved, it’s not always possible to isolate which drug was primarily responsible for the hallucinations. For example, one study reported on 112 patients (62.5% women; average age, 45 yrs) undergoing varicose vein surgery who were given different combinations of anesthetics with similar results. A total of 19 of these patients experienced “sexual” feelings during the surgery: nine had received propofol only, five received propofol 2 mg/kg for induction and then 66% nitrous oxide and 1% 1.5%isoflurane, and five received thiopental with nitrous oxide and isoflurane.
Another study discussed a case in which a woman was given sufentanil (a very potent synthetic opioid analgesic), propofol, and midazolam for sedation to have an epidural catheter implanted for pain management . The patient reported quickly experiencing sexual hallucinations in which she felt the need to show the medical staff a tattoo in her groin area. It is not possible to determine which drug, or specific combination, caused the hallucination.
A warning for health care professionals.
Some classes of drugs can cause patients to hallucinate about sexual assault or sexual fantasies involving their health care professionals. Clinicians and therapists need to understand that although such sexual hallucinations and fantasies are rare, the vivid recollection of the patient’s experiences should be recognized and acknowledged. One patient stated unequivocally that she knew she was not actually sexually assaulted but still decided to discontinue treatment because of how vivid and disturbing the hallucination was to her. Some patients have sought legal action against the accused health care provider.
Health care professionals should inform their patients that sexual hallucinations or fantasies can occur after administration of some sedative hypnotics and that those hallucinations could include feelings of sexual assault. The health care professionals should discuss how they protect patients during the operation, such as witnesses, audio or video recording, or other means. Finally, if a patient experiences sexual hallucination or fantasy, they should be offered access to mental health services.
White M and White CM (2023) The Impact of Sedative Hypnotic Drugs on Hallucinated Sexual Assault or Sexual Fantasies Involving Health Professionals: A Systematic Review. The Journal of Clinical Pharmacology 63(7) 759–768
Schneemilch C, et al., (2012) Sexual hallucinations and dreams under anesthesia and sedation: medicolegal aspects. Anaesthesist. 61(3):234-41. doi: 10.1007/s00101-012-1999-z.
Mancuso C, et al., (2004) Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy. 24:1177-1185.
Blom JD, et al., (2024) The Diagnostic Spectrum of Sexual Hallucinations. Harvard Review of Psychiatry. 32(1):1-14. doi: 10.1097/HRP.0000000000000388. PMID: 38181099
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Gary L. Wenk, Ph.D. , is a professor of psychology, neuroscience, molecular virology, immunology and medical genetics at the Ohio State University.
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