The objective of the study was to evaluate the relationship between the sexual position and severity of penile fracture (PF). We studied 90 patients with PF. The mechanism of injury and the sexual position was assessed. We divided our sample by the etiology of the fracture in six groups: (a) masturbation or penile manipulation; (b) ‘man-on-top’ position; (c) ‘doggy style’ position; (d) ‘woman-on-top’ position; (d) blunt trauma; and (e) ‘rolling over’ fracture. We used the χ2-test for contingency analysis of the populations under study (P<0.05). The patient's age ranged from 18 to 66 years (mean 39 years). Investigation of the injury mechanism identified sexual trauma as the main etiological factor, involved in 69 cases (76.5%). The sexual position at the time of injury varied, with 23 cases (25.5%) occurring in the ‘man-on-top’, 37cases (41%) in the ‘doggy style’ and 9 cases (10%) in the ‘woman-on-top’. We do not observe differences between the severity of the PF between the ‘doggy style’ and ‘man-on-top’ (P = 0.9595), but the ‘doggy style’ had more severity of PF when compared with ‘woman-on-top’ (P = 0.0396) and penile manipulation (P = 0.0026). The ‘man-on-top’ and ‘doggy style’ positions showed more associations with bilateral fractures of the corpus cavernosum and urethral lesions.