The high failure rate of the withdrawal method is not a result of

Medically Reviewed by Traci C. Johnson, MD on August 08, 2022

  • Natural Birth Control
  • Pull-Out Method
  • Emergency Contraception

The pull-out method is a form of birth control in which a man takes their penis out of a woman's vagina before they ejaculate so fewer sperm get inside. It’s also known as coitus interruptus or the withdrawal method.

It isn’t as easy as it sounds. The man needs a lot of control to time it right. It doesn't work if they can't feel when they are close to orgasm or if they're so caught up in the moment that they don't pull out in time.

The best ways to use the pull-out method

Here are some tips to make it work better:

  • Use it along with another type of birth control, like a condom or the pill.
  • Use a spermicide, a chemical that kills sperm.
  • Don't rely on withdrawal alone on the days when the woman is most likely to get pregnant. You can keep track of which days are safest with an ovulation calendar.
  • Have the man pee before sex to clear out any sperm that may have gotten an early start.
  • Be consistent. Do it every time you have sex.
  • When the man ejaculates, make sure none of the fluid gets on the woman’s upper thighs or groin. Sperm on your skin can work its way inside your vagina.

Pulling out isn’t a very reliable way to prevent pregnancy. It works about 78% of the time, which means that over a year of using this method, 22 out of 100 women -- about 1 in 5 -- would get pregnant. By comparison, male condoms are 98% effective when used correctly every time.

Can you get pregnant if your partner pulls out?

Yes, you can. But the pull-out method may work better than doing nothing.

Does the pull-out method prevent STDs?

No, it doesn’t. You can still get a sexually transmitted disease (STD) such as HIV, chlamydia, gonorrhea, herpes, or syphilis while using this method.

Couples may choose this method if they wouldn’t mind a surprise pregnancy or because:

  • They don’t want to use other types of birth control for religious or philosophical reasons.
  • They need some kind of birth control right away, and it’s too late to use other methods.
  • They don’t have sex very often.
  • It's free and convenient.
  • It doesn’t involve any hormones or other chemicals.
  • It has no side effects or health risks.
  • You don't need to see a doctor or get a prescription.

Not only is it not very effective, withdrawal isn’t a good method of birth control because:

  • It takes a lot of control for the man to pull out before ejaculation.
  • The woman has no control over it at all.
  • You may feel that it gets in the way of sexual pleasure.
  • Even if they pee before sex, the man can still release fluid before they ejaculate. This pre-ejaculate does contain sperm.

If you're worried the method did not go as planned, talk to your doctor about emergency contraception, which should be taken as soon as possible after sex to try to prevent a pregnancy.

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NEW YORK (Reuters Health) - Many young women use the “pull-out method” for birth control, and they tend to have more unintended pregnancies than other women, a new study suggests.

Researchers compiling surveys from more than 2,000 women ages 15 to 24 found 31 percent had used the pull-out method, also known as withdrawal or coitus interruptus, over the last two years.

Of those women, 21 percent reported having an unintended pregnancy. In contrast, 13 percent of women who only used other forms of birth control got pregnant unintentionally.

“We found that people tend to use the withdrawal method when they’re not really planning ahead,” Dr. Annie Dude, a resident in obstetrics and gynecology at the Duke University Medical Center in Durham, North Carolina, and lead author of the paper, said.

“It’s a lot more common than many people realize,” she told Reuters Health.

And, Dude added, her study shows withdrawal doesn’t work as well as other birth control methods for avoiding unintended pregnancies.

The most effective birth control methods are longer-term reversible contraceptives, such as intrauterine devices (IUDs) and implants that go under the skin. Less than one woman in 100 will get pregnant each year using these forms of birth control.

Slightly less effective forms include the Depo-Provera hormone shot, the Pill, the ring and the patch, all with failure rates between two and nine percent per year.

When used properly, withdrawal carries about the same risk of pregnancy as condoms and diaphragms, with failure rates of 15 to 24 percent per year. But because withdrawal requires good timing and communication between partners, some experts estimate that failure rates may be even higher, between 18 and 28 percent.

Women who use the pull-out method instead of condoms are also at risk for sexually transmitted infections, such as Chlamydia and HIV.

For the new study, the researchers analyzed information from the National Survey of Family Growth, which contains data about the reproductive behavior of American women ages 15 to 44. Data were collected from 2006 to 2008 by interviewers and with self-administered computer surveys.

The researchers looked at the responses of 2,220 sexually active women between the ages of 15 and 24. They separated those women into two groups: women who had used withdrawal in at least one month of the study period, and women who only used other forms of birth control.

Just over one-quarter of women in the study said they had become pregnant during the prior 22 months, on average, and the majority of pregnancies - 59 percent - were unintended, according to findings published in Obstetrics and Gynecology.

Along with participants who used the pull-out method, African American and poor women were more likely than others to have had an unintended pregnancy. Compared to women who only used other forms of birth control, seven percent more withdrawal users had also taken emergency contraception.

“I’m really excited that the authors took a look at the use of withdrawal because it certainly reflects what I see in my own clinical practice,” said Dr. Nancy Stanwood, section chief of family planning at the Yale University School of Medicine in New Haven, Connecticut.

Most unintended pregnancies happen among women between the ages of 15 and 24, so looking at the use of less effective birth control methods in this population is important, Stanwood told Reuters Health.

According to the Centers for Disease Control and Prevention, approximately 37 percent of U.S. births between 1982 and 2010 were unintended at the time of conception. Over three-quarters of births to women ages 15 to 20 were unintended and half of births to women ages 20 to 24 were unintended.

Having an unintended pregnancy is tied to poor prenatal care, which in turn is linked to birth complications including low birth weight, neonatal death and higher healthcare costs.

“The main point this study makes is that withdrawal as a form of contraception is more common than we thought,” Stanwood said.

“It’s associated with higher risk of unintended pregnancies, and higher risk of using emergency contraception. Women who use it might not recognize the degree of the risks they’re taking.”

SOURCE: bit.ly/16oIc70 Obstetrics and Gynecology, online August 5, 2013.

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