What is the Most Dangerous Sexual Position that Causes Penile Urethra Fracture?

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.