People do die having sex; if they don’t, they can get severely injured. This is something that’s notoriously difficult to categorize or rank, though.
The US Centers for Disease Control and Prevention (CDC) lets you see how many people in the US have died from “exposure to sunlight”, so it caters to vampires, but the closest we can find to sex-based injury appears to be the very ambiguous “overexertion from repetitive movements” and “exposure to vibration.”
Even the estimates for death via sex-induced heart attacks vary wildly. One places the number at around 11,000 victims in the US alone – mostly elderly men, it seems. Another suggests that the number is far lower, in the tens or hundreds of people per annum.
Ladies and gentlemen, this is nothing short of a logistical nightmare. The best we can do is rank sexual acts in terms of number of accidental injuries they are related to.
So, in ascending order – and leaving out some of the more (ahem) imaginative forms of reaching that naughty nirvana – here are the most inadvertently dangerous sex acts, according to science.
6 – Oral Sex
Again, this is difficult to verify, but there are very few studies or reported cases on accidental injuries as a result of oral sex.
You can imagine that there’s a fair few, of course – words like “blowjob” could be wildly misinterpreted – but whether it's fellatio or cunnilingus, the risk of inadvertent injury is insignificant. You’re more likely to injure yourself if you engage in autofellatio, which has been known to cause a handful of spinal injuries.
5 – Use of Sex Toys or Objects
The problem with trying to rank this is that sex toys come in very different shapes, sizes, and types. There’s no single category for “injury via sex toy” in any scientific study we can find.
One analysis, in the journal Sexual Medicine Reviews, notes that “urethrovesical foreign bodies result mainly from sexual or autoeroticism practices and need individualized management.” This means that objects inserted into the urethra, which often cause considerable harm, are so diverse that each treatment is unique to the situation.
As there’s simply not enough data available, we’re going to make a reasonable assumption that this is more dangerous than oral sex, but not as risky as adventures involving an actual penis.
4 – Cowgirl
Yes, vaginal tearing is awful and does happen, but accidental injuries of this kind are rare. The vulva and vagina are relatively hardy – after all, babies are a lot more traumatic than penises are, in general, and they survive that.
The penis itself, however, is extremely prone to fracturing, and while uncommon, the incidence of this coitus-based catastrophe taking place is probably being underestimated. As noted by a study in the International Journal of Impotence Research, “some patients may be too embarrassed to seek medical attention from emergency rooms.”
Several studies have attempted to rank various sexual positions over the years, generally focusing on the risk of penile fracture, or PF. The aforementioned study, which came out just this year, found that in terms of 90 patients with surgically identified PF injuries, cowgirl was the least associated sexual position, accounting for 10 percent of cases.
3 – Masturbation (and general hand-to-genital contact)
Masturbation is certainly one way to cause injury to the penis, particularly if it’s overzealous. Yes, if you get creative you may get something wedged into your vagina that can cause lacerations, but again, you can only bend a penis so far before you hear a terrible, gut-wrenching pop, followed often by a crimson fountain.
In this sense, “penile manipulation” – which, granted, also involves tucking in your tiny soldier into your trousers and other such tasks – accounts for 18 percent of those 90 cases of PF, according to the same study.
Incidentally, according to the authors, in “Eastern countries, there is a higher incidence of cases associated with penile manipulation,” specifically the kind designed to force your willy to wilt.
“As many patients believe that the penis has a bone structure or cartilage, and that these are responsible for erections, they may try to manipulate their penises and make them snap – like fingers,” they note. Blimey.
2 – Missionary
The same study places missionary next, which leads to PF in 26 percent of those 90 cases. They suspect that, unlike any woman-on-top positions, the more frequently vigorous nature of the male-dominated sexual activity leads to a “great impact at the time of trauma” when the penis slips out for a brief moment.
1 – Doggy Style (in general)
Regardless of gender, and regardless of the, er, entry point, doggy style seems to result in the majority of PF, for the same reasons as described above. This study suggests it is responsible for 41 percent of those 90 PFs.
At this point, a caveat is required. Another study from 2014, one that examined causes of PF using similar methods in 42 confirmed PF patients, came to somewhat different conclusions.
Writing in the journal Advances in Urology, the team found that for heterosexual intercourse participants, woman-on-top was the most dangerous position (50 percent of their PFs), followed by doggy style (29 percent of their PFs). Penile manipulation was attributed to 14 percent of all PFs. Only 4 patients out of the 42 experienced PF through homosexual intercourse.
Unlike the more recent research, these academics argue that when the woman is on top, with her full weight on the penis, it’s harder to stop sex if an injury is about to occur.
In any case, it’s difficult to know which study is more accurate, but both rank doggy style quite highly. So, on average, it’s probably the most risky activity overall.
Incidentally, in both studies, heterosexual intercourse appears to be far riskier in terms of PF than homosexual intercourse.
Heterosexual doggy style, for example, was 10 times more likely to result in PF than the homosexual equivalent, according to the 2017 study. The 2014 study reports that 10 percent of PF patients were homosexual, and 67 percent were heterosexual. Both studies involved incredibly small data sets, so it's difficult to know how applicable to the wider world these figures are.
Bonus Round – Fisting
This is described by a review study in the Journal of Forensic and Legal Medicine as “an uncommon and potentially dangerous sexual practice,” one that is “usually a homosexual activity, but can also be a heterosexual or an autoerotic practice.”
Based on the findings of 14 separate peer-reviewed studies, external anal and/or genital trauma is observed in 22.2 percent of cases – a greater than one-in-five chance. Internal injuries, on the other hand, were found in the “totality” of patients. We’d argue, then, that this is the most dangerous and near-conventional sexual activity because some form of injury will always occur.
This, of course, depends on whether you think damage to the vagina or rectum is worse than a penile fracture. Argue among yourselves.
Clarification update: Here's a major problem with attempting this type of list: not all sexual positions are performed at equal frequencies. Only if this was true would you be able to get a proper statistical measure of which positions are more dangerous in this regard.
Nevertheless, there are a handful of studies that have attempted to investigate which sexual activities result in the most hospital reported penile fractures, which is where the ranking comes from.
All of these studies contain very small sample sizes, however, so really this is a somewhat impossible task. Nevertheless, we gave it a go anyway - but best take it with a pinch of salt.