The number of sex-related injuries among middle-aged men has quadrupled in the last five years. Now, if you were to guess, which kind of sex do you think is the most dangerous? While we recently reported doggy-style is most menacing to a man’s penis, the research didn’t account for shower sex, a class of fornication Stephen Makinde, clinical director of Perfect Balance Clinic, insists is the most prevalent sex-related ailment as evidenced by the bevy of men he treats.

It’s a bit of a no-brainer shower sex leads to a ton of embarrassing injuries: there isn’t enough room, it’s slippery as all Hell, water mysteriously causes genital friction, etc. However, Makinde notes sex-injuries, in general, have skyrocketed. “It used to be that injuries associated with sexual activity used to account for a small percentage of the non-sporting cases we treated, around 20 percent,“ Makinde says. “But in the last five years, that’s now increased to around 80 percent.”

He speculates the increase in injury is not solely from sex becoming more dangerous. Rather, Makinde believes people, specifically men, are less ashamed to cop to sex-related incidences (which is quite positive given the circumstance.) However, it’s possible this openness toward sex has also influenced couples to try more difficult positions. With increased difficulty often comes increased injury.

“Most patients are middle-aged males, roughly in their mid-50s, but we do see women who’ve experienced such injuries, too,” Makinde says. “When it comes to [shower] sex, we see everything from neck injuries to wrist fractures, ankle sprains and, of course, back problems.” Hernias are common as well, Makinde notes, where the adductor muscles of the pelvic region become strained. “With the back, we see everything from facet joint locks – where the back spasms and locks in a particular position–to full-blown disc prolapses and sciatic pain.”

Makinde urges that people be honest about how they got their injuries, as it can help speed up treatment. To ensure your next attempt at shower sex doesn’t end in a hospital visit, we’ve offered some safety tips below.

To remedy a slippery surface, invest in a non-slip shower mat, so neither you nor your partner feel like you’re treading on black ice. Since the shower’s built-in soap dish may not be able to support you or your partner’s weight while seeking leverage (no offense), consider purchasing footrests that attach to your shower (they do exist). For added fun, you may also want to incorporate edible soaps, which couples can use as a playful substitute to slippery chocolate syrup.

Because of the limited space and dangerous conditions, it’s essential you choose sex positions that accommodate the environment. Here are three good ones to start with:

Stand and lift: The female should have her arms braced around the other’s neck and their legs around his waist as the other supports the body by lifting the legs and bum (guys, you’re going to have to be strong for this one). Then raise, or bounce, your partner up and down to penetrate. If it helps, lean your back against the wall for added support.

Modified doggy: Similar to the classic, the female should lean forward into the wall with her back to you. It helps if she has a leg up on the tub. Then enter from behind. Bonus: if the shower head is removable, place the shower head on your partner’s clitoris for extra stimulation.

Stand and hook: Standing facing each other, the female should hook a leg around you, then you enter. The only problem for this position is height difference, but a bit of adjusting can quickly rectify that.

Silicone is the best lube for shower play, and you’re going to need lube because water causes a severe amount of friction. However, steer clear of water-based lubricants. Most common, water-based lubricant will wash away in seconds. It might seem convenient, but do not use body washes, shampoos or conditioners as a substitute for lube either, since these items can cause infection. Because condoms and showers don’t play well together (rubbers can degrade during contact or slip off), shower sex should only be practiced with a trusted partner.