What’s up with pulling out?

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?

The withdrawal method is a form of contraception that’s existed since ancient times and is still a common form of contraception today (1). It doesn’t require any shots or pills or doctor visits. It doesn’t even need a condom.

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

Effectiveness

Typical use failure rates of the withdrawal method are up to 27% (1). This means roughly 27 out of every 100 women using this method for a year will become unintentionally pregnant.

When used perfectly, the withdrawal method has a failure rate of 4% (1). 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.

Sexually transmitted infections and pre-cum

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 advance 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 (2). One study shows that over one-third of pre-ejaculate contains sperm (2). 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 (2).

Partner relationships

Sperm-holders 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 (3,4). 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.

What now?

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 (5). But emergency contraception must be used within the first 72 hours after sex (5). Bedsider is a great resource for determining which contraception methods are best for you personally.

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.

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Edit: October 19, 2018 An earlier version of this article incorrectly stated that a 27% failure rate means pregnancy occurs in 27 of 100 times that the withdrawal method is used. Rather, 27 out of every 100 women using this method for a year become unintentionally pregnant.

References

1. Liddon N, O’Malley Olsen E, Carter M, Hatfield-Timajchy K. Withdrawal as a pregnancy prevention associated risk factors among US high school students: findings from the 2011 National Youth Risk Behavior Study. Contraception. 2016. 93(2016) 126–132.
2. Killick SR, Leary C, Trussell J, Guthrie KA. Sperm content of pre-ejaculatory fluid. Human Fertility. 2011 Mar 1;14(1):48–52.
3. Whittaker PG, Merkh RD, Henry‐Moss D, Hock‐Long L. Withdrawal attitudes and experiences: a qualitative perspective among young urban adults. Perspectives on sexual and reproductive health. 2010 Jun 1;42(2):102–9.
4. Randolph ME, Pinkerton SD, Bogart LM, Cecil H, Abramson PR. Sexual pleasure and condom use. Archives of sexual behavior. 2007 Dec 1;36(6):844–8.
5. Meyer JL, Gold MA, Haggerty CL. Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature. Journal of pediatric and adolescent gynecology. 2011 Feb 28;24(1):2–9.