What sexual positions can cause a penile fracture?

Sexual Positions That Can Cause Penile Fracture

Sexual positions where the erect penis forcefully impacts against the female perineum are most likely to cause penile fracture. 1 This typically occurs during vigorous sexual intercourse when the penis slips out and then forcefully strikes against the partner's body.

High-Risk Sexual Positions

• Woman-on-top position: This position carries significant risk because:

  • The partner's full body weight may come down on the erect penis if it slips out
  • The angle of impact can cause forceful bending of the penis against the perineum
  • The man has less control over the thrusting movements

• Doggy-style position: Also presents risk due to:

  • Vigorous thrusting that can lead to the penis slipping out
  • Forceful re-entry attempts that may cause the penis to strike the perineum
  • Misalignment during rapid movements

• Any position involving vigorous thrusting: The risk increases with:

  • Rapid, forceful movements
  • Positions where the penis can easily slip out
  • Attempts at forceful re-entry after slippage

Mechanism of Injury

Penile fracture occurs due to rupture of the tunica albuginea of the corpus cavernosum when the erect penis is forcefully bent 1. During sexual activity, this typically happens when:

1. The erect penis slips out of the partner
2. It then forcefully impacts against the partner's perineum or pubic bone
3. This causes a sudden increase in intracavernosal pressure
4. The tunica albuginea tears, resulting in the characteristic "pop" or "snap" sound

Clinical Presentation

When penile fracture occurs, patients typically present with:

• An audible "pop" or "snap" sound at the time of injury
• Immediate detumescence (loss of erection)
• Rapid penile swelling and ecchymosis (the "eggplant sign")
• Penile pain and possible angulation 1, 2

Important Considerations

• In the United States and Europe, sexual intercourse is the most common cause of penile fracture, while in the Middle East, self-manipulation is more frequently reported 2
• Urethral injury occurs in 10-22% of penile fracture cases, indicated by blood at the urethral meatus, gross hematuria, or inability to void 1
• Prompt surgical exploration and repair is the gold standard treatment to minimize complications such as erectile dysfunction and penile curvature 1, 3
• Non-surgical management is associated with higher rates of complications and should be avoided 1

Prevention

To reduce the risk of penile fracture during sexual activity:

• Maintain proper alignment during intercourse
• Exercise caution during vigorous sexual activity
• Be particularly careful in woman-on-top and doggy-style positions
• Avoid forceful re-entry attempts if the penis slips out
• Use adequate lubrication to prevent excessive friction

Early recognition and immediate medical attention are crucial for optimal outcomes in cases of suspected penile fracture 1, 3.