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    Does the 'pull out' (withdrawal) method work?

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      For lots of people contraception is a tricky subject. It's usually women who are in charge of birth control, but not everyone gets on with standard contraception and you might think condoms "spoil the moment" and they aren't always available.

      It's not surprising then, that some couples rely on the withdrawal or pull-out method, also known as coitus interruptus. According to the WHO, 47millon women worldwide use this method. In 2008 in the UK 3.9 % of all contraceptive users were using the withdrawal method.

      The question is: does it actually work?

      What is the withdrawal method?

      Withdrawal or “pulling out” is exactly what it sounds like – the man removes his penis from his partner’s vagina and genital area before he ejaculates. In theory, this should prevent pregnancy, as it stops his sperm from entering her vagina, and therefore prevents pregnancy.

      Perfect use of this method would mean:  

      • Pulling out before ejaculation every time you have sex 
      • Ejaculating outside the vagina and away from the genitals.

      Remember: Sperm are mobile and can find their way into the vagina even if the ejaculation happened "outside".

      In practice, however, the withdrawal method can be pretty unreliable, which is why it’s not advised as a reliable or standalone method of contraception by the NHS. 

      Considering contraception?

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      How effective is the withdrawal method?

      Statistics about withdrawal method effectiveness will vary depending on who you ask. However, it’s all about technique. If you don’t pull out quickly enough, or if some sperm still gets into the vagina, there’s going to be a risk of pregnancy.

      Planned Parenthood recommends that with perfect use, withdrawal is effective in preventing pregnancy about 96% of the time. This means that for every 100 people who use it perfectly, there will be four pregnancies.

      However, going by typical use, it’s a different story. On average, 22 out of 100 couples will become pregnant from relying on the withdrawal method. That equates to roughly one in five people.

      The withdrawal method works best when you are in a long-term relationship and if both partners are equally keen to avoid pregnancy but know that they might end up pregnant. It can’t really be recommended when you are having casual sex - condoms would be ideal here: they also protect you against STIs.

      One reason why withdrawal isn’t 100% effective – even with perfect technique – is that sperm can be released even before ejaculation. This “pre-ejaculate” or “pre-cum” contains sperm, which is why it can cause pregnancy. Having said this, the withdrawal method is still better than nothing, so if you don't have access to more reliable contraception, this is definitely an option.

      Should I use the withdrawal method?

      The NHS doesn’t recommend withdrawal as contraception, as it’s much more likely to lead to pregnancy than tried and tested methods like the pill.

      Remember, even when done perfectly (which is rare), withdrawal is only thought to be about 96% effective. By contrast, male condoms are 98% effective and the combined pill is 99% effective.

      Another downside is that withdrawal doesn’t offer any protection against STIs. This is why it’s really not recommended in any situations where you aren’t sure of your partner’s STI status.

      However, there might be some circumstances where withdrawal suits you and your sexual partner. For instance, you may be happy to try it if you’re in a committed relationship and open to the idea of having children together.

      Just remember, if you’re going to try the pull-out method, you'll need to do the following:

      • Pull the penis out at the right time i.e. before he feels like he’s going to ejaculate 
      • Ejaculate away from the partner’s genitals to make sure no sperm enters her vagina 
      • Urinate and clean the end of the penis before having sex again, just in case any sperm is still there

      Watch this video from The Right Time, or this one from Planned Parenthood, to learn more about using the pull out method. 

      What should I do if the withdrawal method goes wrong?

      The pull-out method can go wrong quite easily. In the heat of the moment, it’s easy to get caught up and time your withdrawal wrong, meaning that you ejaculate inside your partner’s vagina, or close enough that sperm gets inside.

      If this happens, don’t panic. Emergency contraception is a good option for preventing pregnancy, provided you get hold of it as soon as possible.

      There are two main types of emergency contraception:

      You can get the morning after pill from contraception and GUM clinics, GP surgeries, walk-in centres, and pharmacies. You can also order it from our secure online clinic, and collect it from your nearest LloydsPharmacy store.

      The emergency coil has to be fitted by a health professional at a clinic within five days of unprotected sex. A benefit of this method is that the IUD can be left in and used as routine contraception for several years.

      You can learn more about what to do after unprotected sex by reading this article: What to do if a condom breaks.

      Get routine contraception from Online Doctor

      Women seeking contraception can use Online Doctor to order the pill, patch, or ring. We prescribe combined, mini, and low dose varieties of the pill. Visit our online contraception clinic to find out more.

      References

      https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method/how-effective-is-withdrawal-method-pulling-out
      https://www.un.org/development/desa
      https://www.guysandstthomas.nhs.uk/resources/patient-information/sexual-health/ten-facts-and-myths-about-contraception.pdf
      https://www.nhs.uk/conditions/contraception/male-condoms/
      https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
      https://www.mayoclinic.org/tests-procedures/withdrawal-method/about/pac-20395283  
      https://www.nhs.uk/conditions/contraception/emergency-contraception/

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