What is the ‘pull out’ method?

To prevent conception, the male partner “pulls out” his penis from the female partner’s vagina after limited unprotected intercourse, that is, prior to ejaculation. Doctors commonly refer to this form of contraception as “coitus interruptus” or the “withdrawal method”.

Why do couples use the pull-out method for contraception?

Couples use the pull-out method for a number of reasons, including:

• no immediate cost
• no advance preparation
• lack of access to condoms
• partners’ reluctance to discuss condom use
• when one or both partners don’t want to use one
• the male partner’s expression of ‘caring’ for the female partner
• a meaning of ‘safer sex’
• perception that condom use interferes with pleasure
• perception of ‘negotiated safety’, i.e., trust, closeness, and familiarity
• perception that the male partner is sexually experienced and sexually adept

How effective is the pull-out method?

The pull-out method as a contraceptive option has about a 22% failure rate, according to the Centers for Disease Control. In other words, 22 out of one-hundred women will get pregnant. This compares to about an 18% failure rate for condoms, 9% for the pill, patch, and ring and less than 1% for the IUD, implant, bilateral tubal ligation, and vasectomy.

Why is the contraceptive failure rate so high?

Sperm may be present on the tip of the penis from the prior ejaculate.

Ejaculation control and timing is variable and dependent upon the male partner, his partner, and the sexual situation — Men may not realize that they are about to ejaculate and not pull-out in time. The highest concentration of semen comes first during ejaculation.

What are other reasons “the pull-out method” is a bad idea?

The pull-out method does not protect against sexually transmitted infections (STIs).

Semen (cum) is not the only transmitter of STIs.

Human papillomavirus (HPV) is the most common STI in the United States. HPV is spread through direct contact with infected areas of the skin or mucous membranes. Mucous membranes are found inside the rectum, vagina, penis, and mouth.

HPV can cause genital warts and cancer of the cervix, vulva, vagina, penis, or anus, as well as in the back of the throat, including the base of the tongue and tonsils.

Direct contact between partners’ genitals has risk of transmitting viruses such as genital Herpes Simplex. Partners can also transmit Herpes via oral sex.

A person who has HIV can transmit HIV through blood, semen, pre-seminal fluid (pre-cum), rectal fluids and vaginal fluids. In order for transmission to occur, these fluids must come in contact with mucous membranes or damaged tissue.

Chlamydia and gonorrhea are transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for chlamydia and gonorrhea to be transmitted or acquired. People infected with chlamydia and/or gonorrhea may have no symptoms. Gonorrhea and chlamydia can cause pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain in women.

Why more people are resorting to the pull-out method than before?

According to the National Center for Family Growth, the percentage of women who have ever used withdrawal (among women 15–44 who have ever had intercourse) increased from 56.1% in 2002 to 64.8% between 2011–2015. Withdrawal as the one most effective method used in month of interview among women 15–44 years of age increased from 2.5% in 2002 to 4.4% in 2015–2017. Use of withdrawal reported by men 15–44 years of age asked about the use of any method nearly doubled from 9.8% in 2002 to 18.8% in 2011–2015.

Lack of access to other forms of contraception may explain the increase in prevalence of the withdrawal method. According to Power to Decide, of the 66 million women of reproductive age living in the US, more than 20 million are in need of publicly funded contraception. Among that 20 million, 97 percent (19.5 million) currently live in contraceptive deserts or places without reasonable access in their county to a health center that offers a full range of contraceptive methods.

Other contributing factors to an increase in prevalence of the pull-out method for contraception include how survey questions about contraceptive methods are asked and the introduction of newer forms of contraceptives.

Women’s use of hormonal methods other than the pill increased over a similar period of time with the introduction of injectables, the contraceptive patch, and the ring. Emergency contraceptive pills with less adverse effects became available in 1998 and were approved for over the counter distribution in 2006.

Lastly, the increase in prevalence of the pull-out method may be influenced by changes in cultural norms.