A group of Brazilian doctors recently published a paper in the academic journal Advances in Urology identifying "woman-on-top" (aka cowgirl) as the most dangerous sex position in terms of the sheer number of dicks broken mid-fuck. Analyzing data from three accident and emergency units in the Brazilian city of Campinas over the past 13 years for clear cases of penile fractures (in which the ligament in the penis either tears or overextends, often with a loud, painful crack), the doctors determined that half of all such fractures came when women rode men, with 29 percent resulting from over-vigorous doggy-style and 21 percent resulting from missionary sex.
Those who made it trough the wince-inducing study may have tried to take comfort in the fact that sex-related injuries are rare. As it turns out, that's not entirely true. Urologists at the University of Washington Medical School alone say they see at least one or two penile fractures a month. More generally, a British study found that up to five percent of the workforce takes time off for expressly sex-related injuries every year. And although there's a great deal of under-reporting, self-treating, or misreporting of sex-related injuries, most estimates say that up to one-third of adults will suffer some kind of injury during or directly from the dirty deed—often without realizing the pain they're in until the morning after, thanks to our lovely, sexed-up endorphins.Related: How I Broke My Dick: A Cautionary Tale of Average LengthMany of these injuries could happen outside of carnal embrace: carpet burns, pulled muscles, sprains, and the like. But many more are fairly serious, associated with specific sexual scenarios, and utterly avoidable with the proper precautions.To save ourselves some grievous harm at the most unfortunate of times, VICE dove into the literature on sex-related injuries and spoke with renowned sex therapist Dr. Kat van Kirk to create a list of the six most injurious heterosexual sexual positions and situations. (While there is overlap between heterosexual and homosexual sex injuries for both men and women, there are enough differences to merit their own future posts.)
Our rankings were based on the severity of injuries involved and the frequency with which practitioners encounter them. We also identified the safest heterosexual sexual position, and a few very simple tips to help you avoid serious harm in any position to make sure sex doesn't wreck your bits.
SIX OF THE MOST DANGEROUS HETEROSEXUAL SEX POSITIONS
Photo via Flickr user Abhishek Singh Baloo
The boys from Brazil were right about this one— it's fairly easy to hit things at the wrong angle and get a snap-crackle-pop when a woman puts her full body weight down on a penis."This issue is basically the woman's pubic bone," explains Dr. Van Kirk. "It's slightly differently positioned in each woman. At times there's not enough lubrication when the woman goes to sit on the penis if there's enough force or friction or the penis catches on the pubic bone, that's when that bend will occur in that ligament. That is more common than people think."FYI: Apparently, the angle involved in reverse cowgirl is even more dangerous than cowgirl.
WOMAN-ON-TOP / COWGIRL
This one's mainly dangerous because forceful penetration at the wrong angle can, according to Dr. Kristi Latham, a pelvic health specialist at Dallas's Beyond Therapy & Wellness clinic, cause vaginal tearing (which is least common in cowgirl thanks to the woman's greater power to control depth and motion). Additionally, according to Dr. Kat, deep and vigorous thrusts in a short vaginal canal can cause cervical bruising or even bleeding. But wait! There's more: issue associated with doggy."I'll often see from rear-entry positions guys going to penetrate the vagina and fairly often the penis will accidentally go into the anus," says Dr. Kat. "And because there wasn't any preparation, there can be anal tears and things like that."
DOGGY STYLE AND ITS VARIANTS
Photo via Flickr user Michael Baun
Oral sex is a great fast pass to pink eye if your partner isn't as hygienic as he or she could be, leading to the introduction of fecal matter onto the cornea. But two parties engaging in the practice simultaneously is double trouble when it comes to the sewage-face conundrum.
You'd never expect this one, but apparently men run into trouble when penis meets breast."I've seen a few penile fractures, not just with the pelvic bone, but when guys are in the process of trying to give a pearl necklace," says Dr. Kat. "Sometimes they'll put so much force against the woman's sternum that it can fracture [the penis], and if you're not using any lube, the friction can cause some problems too."
Even the most seemingly boring, safe, and sacred position poses risks. According to Dr. Kat, while it's not as common as in rear-entry positions, it's pretty easy for women with short vaginal canals to suffer cervical bruising or other abrasions from deep thrusts.
SIX OF THE MOST INJURIOUS SEX SITUATIONS
Photo via Flickr user Abhishek Singh Baloo
"Regardless of position, one of the main things I see are vaginal and penile abrasions from not enough lubrication," says Dr. Kat. "If there's not enough lube and you're just trying to force things or if you're just jumping into it without a whole lot of lubrication or foreplay, it can cause nasty abrasions. I've seen those get infected pretty regularly."Unfortunately, just slathering on lube isn't good lubrication either, because so many people wind up having allergic reactions to many over-the-counter gels (and condoms and sex toys) leading to further irritations.
POORLY LUBRICATED SEX
This one's simple: if you're out of shape or doing something you're not used to, you just might hurt yourself. Lifting someone at the wrong angle or bending in the wrong way can lead to pulled muscles at best and broken extremities and heart attacks at worst, especially when you're getting down on iffy surfaces like stairs or rickety tables."People trying to do things in the shower or in their cars," says Dr. Kat, "there I see things like actual broken bones just from trying to do things that might be outside of their typical range."
UNCHARACTERISTICALLY ACROBATIC SEX
Although usually low-level injuries are related to excessive spanking or hair pulling, at times people try whips and chains and other exciting things without reading up on how to properly use them. This trend actually spiked during the release of the 50 Shades books and movies, and seems to be on the rise in general, probably thanks to the rise in awareness of kinky lifestyles in the media but not a concurrent rise in open, candid, and common conversations on safe kink sex practice."I don't see it typically with people who have practiced it for a long time or at least with one partner who is well versed," says Dr. Kat. "But things that have been wrapped around the penis or limbs too long or too hard and causing bruising or contusions or things of that nature. Most of those practices, if they're done responsibly, are not very unsafe [though]."
UNPRACTICED KINK SEX
Whether in the anus or the vagina, men and women often forget that they've placed things inside of themselves, leading to lodged objects only discovered much later."Lost condoms, lost tampons, lost sex toys, and sometimes other lost items that shouldn't be used for sex toys in the anus and vagina," says Dr. Kat. "Especially when people have been drinking or using some kind of substance, their judgment is off and their ability to sense and feel sensation might be altered in some way. I've seen it plenty of times: People won't even realize that something was stuck there. They either figure that the condom got thrown away or that the little vibrator was taken out at some point.Then they present because of other symptoms like infection symptoms, [like] itching and discharge. The cervix can become so inflamed that it bleeds. I've seen it more with men than with women [in the anus]. Retrieval requires emergency personnel because you have to employ ultrasounds or x-rays, because the anus can go up into the colon." Hope you have health insurance!
The presence of fecal matter during sex can lead to the contamination of the urinary tract for men and women (but more often and more acutely for women) leading to urinary tract infections. Cleanliness isn't just a matter of wandering fecal matter, though. More often than you'd think, spicy food on hands and lips becomes an irritating issue during sex.
As you might imagine, sex just isn't as enjoyable or relaxing when you're stressed out. But according to Dr. Latham, it can become physically painful as well due to the over-clenching of the pelvic floor, causing orgasms to feel more spasmodic and causing unpleasant sensations during penetration in women due to reduced flexibility.
For those discouraged about their (heterosexual) sexual safety, take heart: there is one sexual position that seems, anecdotally and wholly unscientifically, safer than the rest.
A LESS DANGEROUS SEX POSITION FOR ALL!
"Even probably better than missionary when it comes to sex is the side-by-side position," says Dr. Kat, "which is typically recommended to couples who are pregnant.""There's no real pressure on any specific joint. Insertion, even though it's typically through rear-entry and not through the front, usually has a little bit of buffer with the body so the penis won't hit the pelvic bone as quickly or bruise the cervix as often."But just because this position is inherently safer than most others, that doesn't mean that you should only spoon-fuck from here on out. Every position can be a safe position so long as a few very basic and fundamental precautions (and preconditions for good sex) are observed."All [positions] are very safe if you're lubricated," says Dr. Kat, "if you're communicating, and if you're not trying to force things before somebody's ready."If you do wind up suffering some manner of injury, it's not the end of the world. Most can be treated with simple approaches like icing, rest, or cranberry juice. But for serious pain, just suck it up and visit a doctor. You don't want to fuck over your sex life permanently, do you?Follow Mark on Twitter.