The withdrawal method of contraception, also known as “pull-out” method or “coitus interruptus”, is a form of birth control where one partner removes their penis from the other partner’s vagina and away from their partner’s genitals before they ejaculate, which usually happens at or around the time of orgasm. In most healthy individuals, ejaculatory fluid (also known as “cum”) contains enough sperm to potentially get someone pregnant. By withdrawing, sperm should theoretically never reach their partner’s egg and pregnancy is not possible. No sperm, no problem.
Is the pull out method effective?
The withdrawal method is generally not considered an effective form of birth control. Out of every 100 people using only withdrawal as birth control, an estimated 22 to 27 of them will get pregnant within one year (1, 2). Even with theoretical “perfect-use”, an estimated 4 out 100 people would get pregnant within one year, but this “perfect-use” rate is rarely seen (2). Given that the withdrawal method should theoretically work (no sperm, no problem, right?), why do we see such high rates of failure using this method?
One reason is that the method is difficult for some to use. It can be easy to forget to withdraw in the moment, or someone may not realize they are about to ejaculate and withdraws too late (3). Withdrawing correctly, every time, requires a high degree of control and self-awareness from the withdraw-er, and of trust from the withdraw-ee: the control of this method’s use is fully in the hands of one person, and there is no way to tell if it’s been practiced correctly after the fact.
A second, commonly-claimed, reason is that sperm may be present in pre-ejaculatory fluid (or “pre-cum”) (4). Pre-ejaculate is released before ejaculate as lubrication for sex and to help balance the acidity in urethra, since the male urethra is used for both urination and for transmitting sperm (3–8). Whether pre-ejaculate contains sperm and whether that sperm could actually get someone pregnant are under-researched questions, and the results among studies don’t always agree. The short answer is yes, pre-ejaculate can release sperm, but this might not be the case for every person.
Is there sperm in pre-ejaculate (“pre-cum”)?
As of winter 2017, there were only five studies looking at the sperm content of pre-ejaculatory fluid. In two of these studies, none of the participants had sperm in their pre-ejaculate (6,7). In the other three studies, between 16 and 41 percent of participants had sperm in their pre-ejaculate (3–5). In these studies, the amount of sperm was low and not all of the sperm may have been able to fertilize an egg (3–5), but there would still be a risk of pregnancy.
There are a few reasons as to why the studies don’t agree. In one study, the researchers found that people who produced sperm in pre-ejaculate always had sperm in their pre-ejaculate, while people who didn’t produce sperm in their pre-ejaculate never did (4). Given that the sample sizes for all studies were small (all had less than 30 participants), it’s possible that, by random chance, some studies didn’t include participants that had sperm in their pre-ejaculate. Also, research methods and the laboratory tools used by the study differed, such that it’s possible sperm was destroyed in some cases, and therefore unable to be examined (9).
It’s a commonly reported idea that sperm in pre-ejaculate is “left-over” sperm from previous ejaculations and that if a person urinates prior to sex, they won’t have sperm in their pre-ejaculate (4). This doesn’t seem to be true.
In the study where 41% of participants had sperm in their pre-ejaculate, the researchers stated that all participants had urinated prior to giving their pre-ejaculate sample (4). This means that the sperm that was present in their pre-ejaculate was “new” sperm or, less likely, that urinating doesn’t entirely clear the urethra of sperm from previous ejaculate.
No sperm, no problem?
This method of birth control is popular, most likely because it’s free and doesn’t require pre-planning (you don’t need a prescription or need to go to the store ahead of time), but its use varies by age, race/ethnicity and country (10, 11). Also, it’s not more popular than other methods. In the United States, 6 in 10 women will use withdrawal at least once in their lifetime, but about 9 in 10 will use condoms at least once (10). In Europe, use of only the withdrawal method (without any other form of birth control) varies from about 1 out of 100 people to 33 out of 100 people, depending on the country, while intrauterine devices (IUDs) are used by 9 out of 100 to 24 out of 100 people (11). Also, not all people using the withdrawal method are using only this method; many use it in conjunction with condoms, spermicide and/or periodic abstinence (i.e. not having sex during specific times) (10,11).
Withdrawal can be an effective form of birth control for some people. Partners who withdrawal will work best for are partners:
who know their bodies’ signs of an upcoming ejaculation,
who are self-disciplined enough to withdraw despite temptations not to,
who trust one another to use the method as agreed, and communicate any errors,
and who do not produce sperm in their pre-ejaculate.
Although the first three conditions are things a person may be able to learn and work on, it’s impossible to tell without laboratory tests if a person has sperm in their pre-ejaculate.
Of course, pregnancy isn’t the only thing a person needs to worry about when it comes to sex. Even if a person doesn’t have sperm in their pre-ejaculate, pre-ejaculate can transmit human immunodeficiency virus (HIV) (7,9) and potentially other sexually transmitted infections (STIs).
If you’re thinking of using withdrawal with your partner(s), it’s a good idea to think about how comfortable you would be with a potential pregnancy and to get tested for STIs prior to use. If you and your partner(s) have both received clean laboratory tests for STIs (which is the only way for a sexually active person to know they and their partner don’t have an STI, since many STIs don’t have noticeable symptoms) and are okay with a potential pregnancy, then the withdrawal method might be a good fit for you. For extra protection, you could buy emergency contraception ahead of time and have it ready in your home in case the withdraw-er doesn’t pull out in time.
If you and/or your partner absolutely don’t want to get pregnant at this time (or at any time) and don’t know your STI status, the withdrawal method is probably not a good fit for you.
Regardless of what method of contraception or STI prevention you chose to use, you can use Clue to track your sex habits, signs of pregnancy, and symptoms of STIs.
References
- Curtis KM, Tepper NK…Whiteman, MK. US medical eligibility criteria for contraceptive use, 2016. MMWR. Recommendations and Reports. 2016;65.
- World Health Organization. Family planning/contraception. Fact sheet 351. 2017, July. http://www.who.int/mediacentre/factsheets/fs351/en/
- Kovavisarach E, Lorthanawanich S, Muangsamran P. Presence of Sperm in Pre-Ejaculatory Fluid of Healthy Males. Journal of the Medical Association of Thailand. 2016 Feb;99:S38–41.
- Killick SR, Leary C, Trussell J, Guthrie KA. Sperm content of pre-ejaculatory fluid. Human Fertility. 2011 Mar 1;14(1):48–52.
- Pudney J, Oneta M, Mayer K, Seage G, Anderson D. Pre-ejaculatory fluid as potential vector for sexual transmission of HIV-1. Lancet 1992; 340:1470.
- Zukerman Z, Weiss DB, Orvieto R. Does preejaculatory penile secretion originating from Cowper’s gland contain sperm?. Journal of assisted reproduction and genetics. 2003 Apr 1;20(4):157–9.
- Ilaria G, Jacobs J, Polsky B, Koll B, Baron P, Maclow C, Armstrong D, Schlegel P. Detection of HIV-1 DNA sequences in pre-ejaculatory fluid. The Lancet. 1992 Dec 12;340(8833):1469.
- Lampiao F. Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?. International Journal of Medicine and Biomedical Research. 2014;3(1):1–4.
- Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
- Daniels K, Jones J. Contraceptive methods women have ever used: United States, 1982–2010. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2013 Feb 14.
- Spinelli A, Talamanca IF, Lauria L. Patterns of contraceptive use in 5 European countries. European Study Group on Infertility and Subfecundity. American Journal of Public Health. 2000 Sep;90(9):1403.
