We've all heard of the pullout method, aka withdrawal or "coitus interruptus" to Latin scholars, but what exactly is withdrawal and how effective is it?

Sex on Female First

Sex on Female First

The withdrawal method is a form of contraception that's existed since ancient times and is still a common form of contraception today. It doesn't require any trips to the doctor or prescriptions. It doesn't even need a condom.

To most people, that sounds pretty great. However, the withdrawal method has some significant downsides.

Does it work?

Typical use failure rates of the withdrawal method are up to 27%. This means pregnancy will occur 27 out of 100 times when the withdrawal method is used for a full year.

When used perfectly, the withdrawal method has a failure rate of 4%. Perfection, though, is not what happens in real life. For perfect execution, your partner must pull out before ejaculation and has to make sure both the ejaculate (cum) and pre-ejaculate (pre-cum) are away from the vagina and vulva. That requires a lot of self-control and self-awareness on your partner's part. Add a little alcohol or a lot of passion and the heat of the moment can override common sense. These are some of the reasons why withdrawal has such a low rate of effectiveness in typical use.

What are the risks?

When the withdrawal method is used without a barrier method (e.g. condom), it cannot stop STIs (sexually transmitted infections) or sperm that's in pre-ejaculate or ejaculate.

Knowing the STI status of your partner is crucial when barrier methods are not used. This requires some advanced knowledge about your partner, so the withdrawal method is less ideal with someone you have just met. If you're worried that either you or your partner may have an STI, getting tested can resolve that uncertainty.

Another thing to consider is pre-ejaculate. Pre-ejaculate is a small amount of fluid released during sexual arousal and before ejaculation. One study shows that over one-third of pre-ejaculate contains sperm. The number of sperm in pre-ejaculate is relatively low compared to the sperm count in ejaculate, so the withdrawal method should actually be seen as an exercise of conscious risk taking for both pregnancy and STIs.

What to keep in mind

Men need to be self-controlled and self-aware for the withdrawal method to work effectively, so it's important to know your partners possess these qualities. It is also helpful if you share a common set of values in case an unplanned pregnancy occurs.

Withdrawal is often preferred over condoms because they are believed to cause discomfort and decrease pleasure and intimacy. However, the consequences of using an unreliable method, such as unplanned pregnancy, miscarriage, abortion or carrying a pregnancy through to full-term, may not affect the partner or affect them differently. These potential burdens are significant. Talking to your partner about your concerns may help in these situations. You may also consider talking to a professional or seeking the guidance of someone you trust.

Is there an effective way of using the pull out method?

Withdrawal can be effective when used with another form of contraception, such as the pill or a condom. Using two contraceptive methods provides "dual protection." Emergency contraception is a common option when using less reliable forms of contraception including diaphragms, spermicide and withdrawal method. But emergency contraception must be used within the first 72 hours after sex.

The big take away for the withdrawal method: it doesn't reliably prevent unwanted pregnancies or prevent the spread of STI. It may be better than nothing, but it's probably not the best option for most people.

Research by Scientific Experts at menstrual health app, Clue (www.helloclue.com)

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