What is the Most Dangerous Sexual Position that Causes Penile Urethra Fracture?
DOI:
https://doi.org/10.33719/sexscij.2508.16Keywords:
penile fracture, sexual position, doggy style, man-on-top, woman-on-topAbstract
Objective: Penile fracture (PF) is a rare urological emergency typically resulting from blunt trauma to an erect penis. While sexual intercourse is the most common etiology, the impact of specific sexual positions on injury severity remains underexplored. This study aims to evaluate the relationship between sexual position and the severity of penile fracture, with a focus on corpus cavernosum rupture and associated urethral injury.
Materials and Methods: A retrospective analysis was conducted on 252 patients diagnosed with PF between January 2009 and July 2024. Epidemiological data, trauma mechanisms, clinical presentation, and surgical findings were assessed. Patients were categorized based on sexual position at the time of injury: “man-on-top,” “woman-on-top,” and “doggy style.” Severe PF was defined as bilateral corpus cavernosum rupture with or without urethral injury.
Results: The mean age of patients was 35 years. Sexual intercourse accounted for 75.5% of PF cases. Among sexual positions, “doggy style” (41%) and “man-on-top” (25.5%) were most frequently associated with PF, and also with higher rates of severe injury. Complete urethral rupture occurred only in cases with bilateral corpus cavernosum rupture. Statistical analysis revealed a significantly higher incidence of severe injuries in the “doggy style” and “man-on-top” positions compared to “woman-on-top” or penile manipulation.
Conclusions: Sexual activity is the leading cause of PF, and certain positions, particularly “doggy style” and “man-on-top,” are significantly associated with more severe injuries. Awareness of these patterns may assist clinicians in anticipating complex trauma during evaluation and surgical planning.
References
Kominsky, H., Beebe, S., Shah, N., & Jenkins, L. C. (2020). Surgical reconstruction for penile fracture: A systematic review. International Journal of Impotence Research, 32(1), 75–80. https://doi.org/10.1038/s41443-019-0212-1
Médéus, A. J. R., Saint Hubert, S., Sinha, M., Saint Jusca, K. E. (2024). Management of penile fracture with complete urethral transection in a resource-limited setting: A case report. Clin Case Rep. 12(10), e9488. https://doi.org/10.1002/ccr3.9488
Barros, R., Schul, A., Cavalcanti, A. G., Favorito, L. A., & Koifman, L. (2021). Findings regarding non-sexual penile fracture in a referral emergency hospital. International Brazilian Journal of Urology, 47(2), 388–394. https://doi.org/10.1590/S1677-5538.IBJU.2020.0420
Morische, S. K., Fürschke, A., Gilbert, N., Osmonov, D., Merseburger, A. S., & Brozat-Essen, S. (2025). Vergleich von diagnostischer Sicherheit durch Sonografie und MRT-Bildgebung bei Penisfraktur – eine retrospektive Datenanalyse [Comparison of ultrasound and magnetic resonance imaging in diagnosing a penile fracture: A retrospective data analysis]. Aktuelle Urologie. Advance online publication. https://doi.org/10.1055/a-2606-4501
Haider, S. M., Khan, M. S., Amir, M., & Zaidi, A. R. (2025). Accidental penile trauma resulting in a fracture: A case report. Cureus, 17(6), e85860. https://doi.org/10.7759/cureus.85860
Joe, W., Owen, K., Ivander, A., Jaya, A. P., Palgunadi, I. N., Adhyatma, K. P., Soebhali, B., & Nasution, R. (2024). A systematic review and meta-analysis of surgical approaches in pelvic fracture-associated urethral injury in children: Primary endoscopic realignment versus delayed urethroplasty. Injury, 55(10), 111728. https://doi.org/10.1016/j.injury.2024.111728
Barros, R., Silva, M., Antonucci, V., Schulze, L., Koifman, L., Favorito, L. A. (2018) Primary urethral reconstruction results in penile fracture. Ann R Coll Surg Engl. 100(1),21. https://doi.org/10.1308/rcsann.2017.0098
Baba, D., Ekici, N., Taşkıran, A. T., Şenoğlu, Y., Başaran, E., & Balik, A. Y. (2025). Complete urethral rupture accompanying penile fracture: A case report. BMC Urology, 25(1), 45. https://doi.org/10.1186/s12894-025-01726-6
Freton, L., Madec, F. X., Fourel, M., Peyronnet, B., Neuville, P., Marcelli, F., Morel Journel, N., & Karsenty, G. (2024). Le traitement des sténoses urétrales postérieures masculines : post traumatiques et post traitements à visée prostatique, techniques et résultats [Management of male posterior urethral stenosis following trauma and prostatic treatments, techniques and results]. The French Journal of Urology, 34(11), 102716. https://doi.org/10.1016/j.fjurol.2024.102716
Zulfiqar, M., Hussain, M., Abedi, S., Gazder, T. U., Rabiullah, S., & Kumar, S. (2025). Long-term outcomes of anastomotic urethroplasty for pelvic fracture urethral injury: The experience of a decade at Sindh Institute of Urology and Transplantation. Journal of the Pakistan Medical Association, 75(5), 730–734. https://doi.org/10.47391/JPMA.11611
Krishnani, H., Anjankar, A., Kakar, G., Sharma, S., & Kumar, A. (2022). Penile fracture with urethral bleeding: A urological emergency. Cureus, 14(11), e31373. https://doi.org/10.7759/cureus.31373
Katsuta, J., Horiguchi, A., Shinchi, M., Ojima, K., Takekawa, K., Furukawa, Y., Minami, T., Suzuki, S., Masumoto, H., Watanabe, D., & Ito, K. (2025). Preliminary evaluation of nontransecting anastomotic urethroplasty for pelvic fracture urethral injury: Insights from a comparison with excision and primary anastomosis. International Journal of Urology, 32(6), 672–678. https://doi.org/10.1111/iju.70027
Barros, R., Schulze, L., Ornellas, P., Koifman, L., & Favorito, L. A. (2017). Relationship between sexual position and severity of penile fracture. International Journal of Impotence Research, 29(5), 207–209. https://doi.org/10.1038/ijir.2017.18
Suzuki, S., Horiguchi, A., Minami, T., Takekawa, K., Furukawa, Y., Segawa, Y., Ojima, K., Shinchi, M., Watanabe, D., Ito, K. (2025) Non-Transecting Anastomotic Urethroplasty Versus Excision and Primary Anastomosis for Non-Traumatic Posterior Urethral Stenosis: A Preliminary Feasibility Study. Int J Urol. 32(8), 953. https://doi.org/10.1111/iju.70073
Kasaraneni, P., Mylarappa, P., Gowda, R. D., Puvvada, S., & Kasaraneni, D. (2019). Penile fracture with urethral injury: Our experience in a tertiary care hospital. Archivio Italiano di Urologia e Andrologia, 90(4), 283–287. https://doi.org/10.4081/aiua.2018.4.283
Cui, K., Hong, P., Fang, H., Lin, J., Hu, Z., Tian, X., Zhang, D., Wu, S., Liu, X., Shi, Q., & Wei, G. (2025). Treatment and prognosis of pelvic-related urethral injuries in children: A 20-year single-center study and systematic review. BMC Pediatrics, 25(1), 277. https://doi.org/10.1186/s12887-025-05611-x
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