Safety First: The Most Risky Sex Positions

Great sex requires comfort and trust, but there also needs to be mindfulness and caution.

Without careful communication, respect for boundaries, and an understanding of each person's comfort and physical capabilities, some sex positions can lead to bodily harm.

Several sex positions stand out for potential risk, and you may be surprised to hear this includes some common ones. For example, doggy style can cause penile fractures or cervical injuries if you're not paying attention.

Others prefer to go at it with all their might when it's really best to take it slow, as rushing things could put you and your partner at risk.

Some tips for doggy style, missionary and cowgirl

Lilith Foxx, a Board-certified sexologist and inclusivity consultant based in Houston shared a couple of tips to mitigate risk for the popular doggy-style position:

• Controlled penetration. The penetrating partner should be mindful of the depth and speed of their thrusts, being careful not to go too deep or too fast. It's best not to withdraw the penis completely during thrusts, as that increases the risk of "missing."
• Pillow support. Placing a pillow under the receiving partner's hips can help control the angle of penetration.

Even the most vanilla sexual position carries risk, and we're talking about "Man-on-Top" or missionary position. When a man's full weight is on his partner, accidental slips could happen, particularly if movements become too vigorous.

Safety is paramount even if your partner takes the reins. For instance, consider the popular "woman on top" position, more commonly known as the cowgirl.

"In this position, the partner on top controls the depth and speed of penetration," Foxx said. "This position is associated with a higher risk of penile fracture because the person on top has more control over the motion, and an abrupt movement could lead to injury."

To ensure safety and pleasure, Foxx said the partner on top should move mindfully, and avoid leaning too far backward while penetrated, as this may hyperextend the penis. Using their hands for support can help control movements, and the partner on the bottom can use their hands to support their penis at the base, providing a "guide" for the person on top.

If an erect penis hits a hard surface such as a partner's pelvic bone, it can cause a penile fracture. A study published in September 2017 focused on 90 men with penile fractures identified the main injury mechanism for 69 of those men was sexual trauma. This included 37 cases involving doggy style, 23 cases of missionary and 9 cases of cowgirl.

The conclusion of the report was to keep things slow, controlled and consensual, which goes a long way in ensuring both your partner's safety and pleasure.

Let's get more adventurous

As we move away from vanilla and venture toward more adventurous forms of sexual expression, it's increasingly crucial to be mindful of potential risks. Here are three sex positions that, while perhaps offering an enticing variety, may increase chances for injury if not approached with caution and clear communication.

The piledriver

This position is not for the faint of heart. It's physically demanding, with one partner upside down, typically balancing on the back of their neck and shoulders, while the other penetrates from above. This position can lead to head and neck strain for the receiving partner, and there's always the risk of a loss of balance leading to injury.

"You can mitigate these risks with pillow support for the receiving partner's head and neck, and have them lean against a couch, bed or wall for balance," Foxx said. "Additionally, you can do an adapted version of this on a bed by having the penetrating partner on their knees thrusting, while the receiving partner is laying on their back and lifting their hips. You achieve similar angles, and the penetrating partner can hold their hips for balance and leverage."

The stand and carry

Intimate and exhilarating, but one that requires strength, balance and a lot of trust. One partner lifts the other, holding their weight while maintaining sexual stimulation and penetration.

It's a real test of raw power, which carries the risk of falls if not performed with care. Foxx recommended using a wall for support or being near a bed where the lifted partner can be dropped safely is a wise precaution.

The wheelbarrow

"This position requires the receiving partner to support themselves on their hands while the penetrating partner holds their legs, which can put a strain on the arms and wrists," Foxx said. "Like the stand and carry, be aware of your strength and limits, as wrists really aren't meant to support your entire weight for too long, and can fracture or strain."

Before getting down and dirty, ensure you've warmed up and are prepared for the physical demands it requires. Consider having the receiving partner rest on a bed or other furniture for support, distributing weight across their forearms and reducing the risk of strain.

The wheelbarrow may bring back memories of childhood, but this time it isn't a competition. It's a collaboration, so have fun.

Make it easier to have safer sex

Despite the inherent risks, don't let fear dictate your intimacy or your options in the bedroom. Rather, let this knowledge inform your intention. A pleasurable and fulfilling experience requires being conscious of yourself and your partner's safety.

Quite simply, leave no room for neglect and regret.

Remember, the bedroom (or wherever your passions may take you) isn't a battlefield but rather a loving dialogue, a rhythmic dance requiring trust, vulnerability and calculated caution.

"When it comes to sexual activities, it's important to prioritize safety and well-being," said Rhiannon John, a New York City-based sexologist who works at Bedbible as a sex toy reviewer. "While preferences and comfort levels vary between individuals, certain activities may have a higher risk of injury if not cautiously and properly communicated. "Engaging in activities such as hanging or suspension, extreme or rough bondage, breath play, impact play, electro play, blood play or sexual encounters in high-risk locations can potentially lead to injuries if not practiced responsibly. These activities may involve strains, falls, tissue damage or, in extreme cases, serious harm or even death."

Ensuring safety in high-risk sexual activities requires specific attention and precautions. John provided some recommendations to make high-risk sex safer:

• Address power dynamics
• Educate yourself
• Establish clear boundaries
• Prioritize consent, communication and safe words
• Start gradually
• Prioritize aftercare

Tell your partner what you like and ask them, too

A good strategy for improving communications about sex is to start the conversation before things get hot and heavy, suggested Avril Louise Clarke, a sexologist and intimacy coordinator at ERIKALUST, based in Barcelona, Spain.

"Having it outside of the bedroom is key," she said. "In the bedroom, people try to force the conversation and it creates an uncomfortable space where they shut down and don't communicate their likes and dislikes. The practice of consent may not always be easy for the person trying to initiate the conversation, it may feel awkward at first. But just know that this is OK. And practice doesn't always make perfect but it helps."

Rebecca Alvarez Story, a San Francisco-based sexologist and CEO/co-founder of the sexual wellness and intimate products website Bloomi, said it's always good to start with a positive opener, and tell your partner what you enjoy and appreciate. She recommended being specific when describing your wishes and desires as well as any potential issues related to your sex life.

"Sex communication takes time and practice to get comfortable and it's important for all parties in order to feel listened to and respected," she said. "When you're having sex, it's good to give your partner verbal and non-verbal feedback and tell them what you like/dislike. However, if you want to have a broader conversation on sex, then it's better to talk about it when everyone is relaxed and all partners can fully dedicate their energy to a conversation."

When discussing issues, it's never good to use a "you" statement and make your partner feel attacked. She added it's better to frame it in an "I" way and be positive. This will lead to a more constructive solution and better communication.

Story's final advice was not to forget to always ask your partner how they feel and what their thoughts and feelings are. That conversation should always go both ways.