Monday, August 31, 2009

Pulling Out Is In

"What birth control method do you use?" I'll ask every new patient. Some will guiltily answer, "Nothing." "Not even condoms, or withdrawal?" I'll reply. "Oh, yeah, he pulls out. But we don't use real birth control."

The withdrawal method of contraception (also known as coitus interruptus, or pulling out before ejaculation) has never received much respect from doctors. Withdrawal as a method requires awareness of imminent orgasm by the guy - and the ability to pull out in time. It's a method classified as "coitally dependent" - you need to use the method when you have sex instead of planning ahead of time...and lust doesn't always allow for clear thinking in the moment. And pre-ejaculatory fluid, or pre-cum, has long been though to contain a small amount of sperm, enough to render the pulling out action virtually useless at preventing pregnancy.

Withdrawal often isn't even considered birth control by its practitioners. It's commonly considered to be better than no method of birth control - but not by much. Many women consider it a last resort, during unplanned sex without a condom, or during a month with missed pills or a forgot-to-replace ring. And even more women may use withdrawal as a back-up to another method. It's estimated that at least one-third of women use withdrawal for at least some acts of intercourse.

Researchers have difficulty estimating exactly how many couples use withdrawal as a method, since if they're not directly asked, women don't often report it - making it difficult to assess its effectiveness. But it may be time to take another look at withdrawal as a viable birth control option. Why?
  • It's actually pretty effective. Compare pulling out to condoms - both methods are very effective when used perfectly (about 4% vs 2%)...and less good in real practice (about 18% vs 17%). Scary numbers for condom users, maybe, but many couples rely on condoms alone at least sometimes.
  • Not all sex is planned. And when sex is gonna happen, and there's no condoms around, it's the only option available at the moment (until plan B the next morning).
  • Pre-cum may be clear, after all. Recent studies indicate that pre-ejaculatory fluid does not contain sperm (your high school boyfriend may have been right!)...increasing the effectiveness of the method when he withdraws in time.
The usual disclaimers: Withdrawal will not protect you against STDs - only condoms will. It's not nearly as effective as an IUD or hormonal methods of birth control. And it puts the responsibility for her not getting pregnant squarely in his hands (or his hips, as it were), which many women may not feel comfortable with. But as a back-up to another method, or for infrequent or surprise sex, consider pulling out to be much better than nothing at all.

Photo credit: zen

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