The act of inserting your balls in a rectum while having vaginal sex. Easiest done while in the piledriver position.
This act has sometimes been called clowning (after the aggressive street-dance style), but this is the true nomenclature for this rare (and occasionally painful) act.
1. You know how loose that Sara's ass is? Well, I was piledriving her last night and it fell open -- so I gave her a Cleveland Meatball. She didn't even wake up.
2. I was giving that big german chick a Cleveland Meaball, when her husband sneaked up behind us and stuck a pin in her ass. I didn't know that she was married or I woulda been facing the door.