Every Friday on the blog, I answer people’s questions about sex, love, and relationships. This week’s question comes from a reader who wants to know more about the withdrawal method of birth control.

When we don’t have condoms around, I don’t let my boyfriend ejaculate inside of me because I don’t want to get pregnant. We’ve done this several times and I have never gotten pregnant from it, but I always worry about it afterwards. I guess what I want to know is how worried I should be.

Thanks for your question! The withdrawal method (sometimes referred to as “coitus interruptus” or “pull and pray”) can be a highly effective way of preventing pregnancy when performed with perfect use. In fact, research has found that when used consistently and correctly during every single act of vaginal intercourse, the withdrawal method is 96% effective at preventing pregnancy [1]! In other words, with perfect use, only 4 out of 100 women would become pregnant each year if they relied upon this method of contraception alone. That’s almost on par with condoms, which are 98% effective at pregnancy prevention with perfect use.

However, perfect use is rarely achieved with any form of contraception because people make a lot of mistakes. To use the withdrawal method perfectly, both partners must always exhibit a high level of self-control during sex and be satisfied ending intercourse early. Not only that, but the male partner must be flawless when it comes to timing his ejaculation. However, even if his timing is perfect, there’s still a risk of pregnancy when using withdrawal because a man’s pre-ejaculate (also known as precum) often contains active sperm and men cannot control the release of their pre-ejaculate. Consider this: in a recent study, scientists had 27 men collect their pre-ejaculate in a petri dish, which was then immediately analyzed for sperm content [2]. The researchers found that 41% of the samples contained sperm! Thus, it would appear that some guys are sperm "leakers" and there isn’t anything they can do to control it, short of wearing a condom.

Given the above, what we should be looking at are typical use rates when considering the effectiveness of any contraceptive, because these rates account for human error. The typical use rate for the withdrawal method is 78%, which means that 22 out of 100 women will become pregnant over the course of a year if they only rely on this birth control method. In all fairness, the typical use rate for condoms (82%) isn’t much better because people make lots of mistakes when it comes to using condoms properly. However, condoms do have a leg up on withdrawal in the sense that they at least offer some degree of protection against sexually transmitted infections (withdrawal does not prevent infections because there is still an exchange of bodily fluids).

In short, there is definitely cause for concern when using withdrawal when you consider the typical use (i.e., real world) effectiveness rates. If you’re looking for a contraceptive that’s more effective but is still easy to use (i.e., that doesn’t require you to take a pill every day or always have condoms handy), I recommend checking out the intrauterine device (IUD) or contraceptive implant. You can read more about both of these forms of birth control here.

For previous editions of Sex Question Friday, click here. To send in a question for a future edition, click here.

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[1] Trussel, J. (2011). Contraceptive failure in the United States. Contraception, 83, 397-404. doi:10.1016/j.contraception.2011.01.021

[2] Killick, S. R., Leary, C., Trussell, J., & Guthrie, K. A. (2011). Sperm content of pre-ejaculatory fluid. Human Fertility, 14(1), 48-52.

Image Source: iStockphoto.com

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