Doctors Warn of Serious Risk of Penile Fracture from Popular Sex Position

Medics have warned one sex position could be responsible for up to half of all penile fractures, an eye-watering injury that can leave men in agony

Medical professionals have issued a warning about a sexual position linked to a significant number of penile fractures—an intensely painful and serious injury. Despite the penis lacking bones, it can still "fracture" when subjected to sudden, forceful impact during an erection. One position, in particular, has been identified as a leading cause.

Surgeons have highlighted the reverse cowgirl position—where the woman is on top and facing away from her partner—as especially hazardous. If thrusting is erratic or the couple's movements are not in sync, the penis can slip out and be forcefully impacted by the partner’s pubic bone. This injury is typically marked by a sharp popping or cracking sound, followed by rapid swelling and discoloration, making the penis appear purple and swollen—similar to an aubergine.

In 2023–24, the NHS recorded 162 men undergoing surgery for penile fractures, with patients ranging in age from their 40s to late 70s. The average age was 44. A 2015 study from Brazil found that half of all reported fractures occurred during positions where women were on top, with 29% occurring during rear-entry positions. In contrast, the missionary position—man on top—was considered the safest.

However, more recent findings complicate the picture. A 2024 study of nearly 500 penile fracture cases in East Asia found that positions where the man was on top actually resulted in the most injuries. Researchers theorized that greater excitement and dominant positioning during intercourse could lead to vigorous movement and impact trauma.

An erection involves blood filling two sponge-like tubes called the corpora cavernosa, which are encased in a tough fibrous sheath known as the tunica albuginea. A fracture happens when this structure ruptures, often with immediate pain, swelling, and loss of erection.

Experts emphasize that while such injuries can be embarrassing, it is crucial to seek emergency medical care without delay. Delayed treatment raises the risk of complications such as erectile dysfunction, abnormal curvature of the penis (Peyronie’s disease), and chronic pain during erections.

Surgical repair is typically required, involving stitches to the tunica albuginea and any other affected tissues, such as the urethra.

Sex and relationship experts advise that couples can minimize the risk by maintaining open communication, taking things slowly, and prioritizing mutual comfort and control during intimacy.