Pain in the bedroom isn’t always a good thing. Sex-related injuries are surprisingly common, according to a 2014 study by dating app, which found that one third of adults injure themselves during sex every year. And honestly, if you’ve never slipped in the shower while doing it, you might be missing out on some mind-blowing moves.

Certain conditions—such as intoxication and odd locations (ahem, the shower)—definitely increase the chance of injuries, says sex therapist Madeleine Castellanos, M.D, author of Wanting to Want: What Kills Your Sex Life and How to Keep It Alive. Accidents happen, but you can take some preventative measures, says Castellanos.

Here are some common sex injuries she might sustain during sex—and how you can help prevent them.

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1. Beard Burn

A five o’clock shadow looks a lot sexier than it feels—especially if you’re going down on her. Beard burn is a pretty minor sex injury (we’re not sure if it’s really even an injury), but that doesn’t mean you shouldn’t take steps to prevent it. After all, you want her to focus on your impressive technique, not your scratchy face. Luckily, the fix is easy: Shave before you get frisky, or let your facial hair grow long enough so that it’s a soft beard, Castellanos says.

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2. Vaginal Tearing

Vaginal tearing is one of the more common sex injuries, and it usually sounds worse than it is. While many associate vaginal tearing with particularly rough sex, studies have shown that about one third of women experience vaginal lesions. But you can still take measures to minimize damage. “If your partner feels she may be injured, you may need to switch up what you’re doing based on the seriousness,” Castellanos says. “This could be as simple as adjusting a position, or she may need a break from the action for a bit. Make sure the angle and depth of penetration are something that feels comfortable and adjust accordingly before you increase the pace or force of your thrusting. Lubrication, such as Wet Platinum or Replens Silky Smooth can also help.”

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3. Bruising

Hickies can be fun, if a bit embarrassing once you’re past the age of 15, but they can also be dangerous. Seriously! In 2011, a 44-year-old Maori woman was hospitalized after a hickey caused a blood clot, which resulted in a stroke and a paralyzed left arm. Okay, so that’s the only documented case of a hickey-related blood clot stroke, but bruises of the non-hickey kind are still a sex injury to watch out for. 

According to Castellanos, the two places to look out for when it comes to bruising are her breasts and her cervix. “Breasts are quite sensitive and breast tissue is easily bruised, so handle hers with care,” Castellanos advises. Cervical bruising won’t be visible, but it’s definitely a concern. Castellanos’ best advice: Be careful with the thrusting power when you’re in positions that shorten the depth of the vagina, such as doggy style or reverse cowgirl. 

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4. Neck Injuries

Gently pulling her hair can be pretty hot (if she’s in to that kind of thing), until you accidentally sprain her neck. “When there’s a lot of back and forth motion and tugging of hair, her neck can easily get injured, which can result in life-long problems,” Castellanos warns. Don’t worry, you can still play around without giving her a chronic neck injury—just be cautious about pulling her neck too far back, pushing her head during oral sex, or holding her head down to one side. And don’t look to porn for your cues: “Guys need to remember that there may be a much more limited range of motion in reality compared to what’s imagined,” Castellanos says. One final disclaimer: Always, always ensure she’s on board with any rougher foreplay or sex before you even begin. A safe word is a great, injury-preventing, idea, too.

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