Withdrawal

Withdrawal, also known as “coitus interruptusor “pulling out” is a natural method of contraception wherein one partner removes their penis from their partner’s vagina before ejaculation. It is simple, somewhat effective, and always an option. The withdrawal method is not a widely recommended method due to the possible presence of semen in “pre-cum” and because it does not protect against sexually transmitted infections (STI’s). Although we do not recommend this form of contraception in most circumstances, some may choose to use withdrawal because they do not have access to other forms of contraception or because of their religious beliefs.

 

Effectiveness

Among perfect users, the failure rate of withdrawal is 4%, meaning that 4 out of 100 users end up in pregnancy. However, it is important to note that the typical use rate is closer to 24%, meaning that almost 1 out of 4 typical users end up in pregnancy.2 Although individuals who are more experienced with this method and are familiar with their bodies may feel completely in control, it is difficult for many males to determine the exact moment that they will ejaculate. Effectiveness for this method can be increased through urinating after ejaculation, which will clear the urethra of any leftover semen from a previous ejactulation. It is recommended for young adults to use methods of birth control other than withdrawal that protect against STI’s because of their high risk and potential risk for unexpecting pregnancy.1

Pre-Cum

Before ejaculation, a male will usually emit a pre-ejaculatory fluid, known colloquially as “pre-cum.” Pre-cum is made in the Bulbourethral gland, also known as the Cowper’s Gland, close to the urethra. This emission, which usually occurs during the arousal phase, is difficult to control and generally goes unnoticed by the male. Normally the vagina is acidic, which makes it hard for the sperm to travel through it during intercourse. Pre-ejaculatory liquid neutralizes the vagina to facilitate the passage of the sperm. Although there is not usually sperm present in the pre-ejaculatory fluid, it may be possible if a male has not urinated after his last ejaculation. If the male has previously ejaculated, whether through masturbation or through sex, it is important to urinate to remove any semen leftover in the urethra to reduce the chances of pregnancy.

 

History of the Withdrawal Method

Withdrawal is the oldest form of birth control that exists. In ancient Greece and Rome, smaller families were preferred, so individuals used a range of birth control methods.8 There are some ancient writings that could be interpreted as the Greeks using the withdrawal method to prevent pregnancy.8

 

The withdrawal method is still a popular method of contraception today. In a study conducted in 2010 among US women aged 15-24, more than 50% of sexually experienced women have used the withdrawal method before.1 In a more recent 2014 study, it was found that in the last 30 days among women 18-24, the withdrawal method was used 41%.9 This data shows that withdrawal is a common method for birth control with young adults, even though it is not as effective or as safe as other methods.

Advantages of the Withdrawal Method

For individuals without access to other forms of birth control, or those who choose not to use them, there are some advantages to using the withdrawal method. Many people feel comfortable using this method of birth control for medical, personal, or religious reasons. Also, it is free and can be used without any prior planning, thus it is optimal for unplanned sexual encounters. It is also a method that should be used in combination with another method of contraception to maximize the effectiveness of birth control. This method involves no chemicals and no hormones meaning there are no health side-effects sometimes associated with other contraceptive methods, such as hormonal methods like the Combination Pill, Nexplanon, or Nuvaring. Another possible advantage is that the male gets to share some of the responsibility in preventing pregnancy. Also, this method does not need to be reversed by a doctor, unlike the IUD and Nexplanon.

Disadvantages of the Withdrawal Method

There are many disadvantages to using the withdrawal method as birth control. The biggest disadvantage of withdrawal is that it does not provide protection against sexually transmitted infections. STI’s such as chlamydia, gonorrhea, and syphilis can still be spread through pre-cum but at a slightly smaller rate than through ejaculation.4 The best way to prevent the spread of STI’s is to use the male condom. Also, sexual pleasure can be diminished in both partners due to anxiety about the male withdrawing before he ejaculates. For females who wish not to be pregnant, this is not a recommended form of birth control due to poor reliability. For males, it is also not a recommended form of birth control for those who do not have control of when they ejaculate, such as teenagers and young adults.

 

While some couples use this method as a primary form of birth control, this method is not recommended if you are at risk of contracting or passing a sexually transmitted infection. Withdrawal does not offer any protection against STI’s, which include skin-to-skin infections such as genital warts and herpes as well as chlamydia, gonorrhea, and syphilis. Another reason why withdrawal may not be a good option includes not trusting your partner to withdraw in time before ejaculation. According to the CDC, this method is considered “unforgiving” when used incorrectly.5

Pulling Out Too Late

If you think either you or your partner withdrew too late and you are not considering pregnancy an option, the female can take an emergency contraceptive within the first 5 days after the sexual encounter. It is very important to take emergency contraceptive as quickly as possible because some examples of emergency contraceptives including Plan B and the i-Pill are more effective the sooner you take them. After the first 5 days following intercourse, the female can wait to see if she misses her period and can take a pregnancy test.

 

Concluding Remarks

The most effective way to use the withdrawal method is to combine it with other birth control methods. Due to the high risk of STI’s, it is recommended to combine it with barrier methods such as the male condom or the female condom. It is also not recommended as an effective form of birth control for teenagers because of the high prevalence of STI’s and a higher risk of pregnancy.

 

How Effective is the Pull Out Method (AKA Withdrawal Method)? | Planned Parenthood Video

References

  1. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. "Contraception and Abortion." Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2009. Print.
  2. Whittaker, Paul G., et al. “Withdrawal Attitudes and Experiences: A Qualitative Perspective Among Young Urban Adults.” Perspectives on Sexual & Reproductive Health, vol. 42, no. 2, June 2010.
  3. Arteaga, Stephanie, and Anu Manchikanti Gomez. “‘Is That A Method of Birth Control?’ A Qualitative Exploration of Young Women’s Use of Withdrawal.” Journal of Sex Research, vol. 53, no. 4/5, May 2016.
  4. Lampiao F. “Coitus Interruptus: Are There Spermatozoa in the Pre-Ejaculate?” International Journal of Medicine & Biomedical Research, vol. 3, no. 1, Jan. 2014.
  5. “CDC - Coitus Interruptus (Withdrawal) - USMEC - Reproductive Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Feb. 2017.
  6. Mayo, Clinic. “Withdrawal Method (Coitus Interruptus).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Apr. 2018.
  7. Jones, Rachel K, et al. “Better than Nothing or Savvy Risk-Reduction Practice? The Importance of Withdrawal.” Contraception, vol. 1, no. 79, 2009, pp. 407–410.
  8. Collier, Aine (2007). The Humble Little Condom: A History. Amherst, NY: Prometheus Books.
  9. Jones, R. K., Lindberg, L. D., & Higgins, J. A. (2014). Pull and pray or extra protection? Contraceptive strategies involving withdrawal among U.S. adult women. Contraception, 90(4), 416–421.

Last Updated: 19 Feb 2019.

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