An intersting article titled “The Impact of Sedative Hypnotic Drugs on Hallucinated Sexual Assault or Sexual Fantasies Involving Health Professionals: A Systematic Review” appears in the 2023 edition of the Journal of clinical pharmacology written by M. White and M. White. The article seeks to conduct a review on the issue of hallucinated sexual assaults caused by drugs used in denstry like midazolam while dental procedures are peformed on patients. This topic has been covered before on this site see for example the post Hallucinations While Taking Anesthesia: Implications for Sexual Assault.
In the article discussion is made of how real sexault assaults have occured in the medical setting. An example is made of a 21 year old college woman who was given 10mg of diazepam intravenously while having a procedure performed and her doctor innappropriate touched her. Examples of this type of behavior has been convered on this site at https://www.teethremoval.com/sexual_assault_under_anesthesia_for_wisdom_teeth_removal.html. The authors in the current article state:
“These cases not only cause stigma around what health professionals could do to vulnerable patients, but also violates the medical trust between a patient and their caregiver.”
The authors then go on to say how sedative hypnotic drugs implicated in facilitating sexual assault can also cause sexual induced hallucinations. These hallucinations can be vivid and make it difficult to distinguish reality from fantasy and in some cases lead to accusations of sexual assault against medical personnel. The authors conducted a systematic review of PubMed from the earliest possible date through 2/7/2023. The authors reviewed the identified case reports to try to distinguish if a sexual hallucination occured by looking or evidence of having another person in the room at the time of the event, video or audio recordings of the event, or the nature of the situation. The authors also looked at the FDA Adverse Events Reporting System and ran filters for cases related to “excessive sexual fantasies”, “abnormal dreams” and “sexual abuse”. The authors arrived at 87 individual cases of sexual assault or sexual fantasy reported from 17 different articles after reducing down from an original 93 articles.
In the articles identified 10 of the articles showed 16 individual cases where patients or caregivers reported a sexual assault or sexual fantasy after a medical/dental procedure with staff or observers present. In one of these cases a nurse was present for the entire dental operation yet the 38 year old woman patient who had been given 30mg of diazepam believed the dentist fondled her chest during the procedure. In the 71 other cases there was not objective evidence that the sexual assault or fantasy had not occurred. Among all 87 cases, most that beleived they were sexually assault occurred in people 25-30 years old. The benzodiazepine midazolam was used in 36 (41.3%) of the 87 cases. Other medications used in these cases included a combination, diazepam, propofol, and nitrous oxide. In 30 cases where the body parts manipulated during the procedure were reported, in 27 of these the parts of the body that were thought to have been touched in a sexual way by the patient were associated in some way with what was happening during the procedure. Oral procedures were related to oral sex, thoracic procedures were related to breast fondling, abdominal or genital procedures were related to vaginal touching, and hand squeezing was related to the perception of having to squeeze a clinician’s penis.
From the exploration of the FDA Averse Events Reporting System the authors found 46 cases of “excessive sexual fantasies” with 55 individual drugs were reported from the year 2000 to December 31, 2022. Benzodiazepines and propofol only made up 4 of these cases. The authors found 30,728 cases of “abnormal dreams” from 1974 to December 31, 2022. With the majority of cases being with gama-aminobutyric acid acting medication and then benzodiazepines. The authors found 366 cases of “sexual abuse” reported from 1998 to December 31, 2022. The majority of these cases were with opioids and then benzodiazepines.
The authos feel that their finding that females are more likely to report sexual assaults and/or hallucinations and particularly those that are 25 to 30 years old. The authors mention the potential legal implications and state that in five of the 87 cases, there were criminal investigations and one detnist lost their license. Several cases also involved legal action taken by the patient.
The author mention several limitations of their study which includes the cases relied on the patient to recall the event and their experience. Further some cases had more information then others. The authors also metioned that 65% of the cases involved midazolam with 70% of those cases previously reported by John Dundee in his old articles from the 1980s and 1990s such as “Advantages and Problems with Benzodiazepine Sedation,” appearing in Anesthesia Progress (pages 132-137). The authors state that possible reporting bias could have occured because Dundee did not look carefully at other sedative hypnotics besides midazolam.
The authors provide several suggestions to dentists to help reduce the chances of patients believing they were sexually assaulted during procedures with sedatives. First dentists should inform patients of the risk of sexual fantasies or hallucinations when given sedatives. Dentists should also discuss how they protect patients during procedures which can include audio and video tape of the procedure along with witnesses present. Dentists should also offer entists should offer mental health services to patients who experience sexual hallucinations or fantasies as the psychological trauma can be significant. The authors state:
“[T]here have been cases of reported sexual hallucinations or fantasies after administration of a sedative hypnotic drug during a medical or dental procedure…. There are multiple ways to be able to limit the negative aftermath of this rare side effect such as discussing the risks ahead of time, having recorded evidence, always having an assistant present, and providing mental health services to patients who experience this side effect.”
The authors mention that in the future a larger dataset can help provide more definitive answers.