This was posted earlier today, but I had a few more thoughts so here is an expanded version. Sorry to the commenters who have already begun this discussion!
Guttmacher Institute, a reputable and well-respected reproductive health think tank asked this question in it's latest report. From the report:
Withdrawal is sometimes referred to as the contraceptive method that is "better than nothing." But, based on the evidence, it might more aptly be referred to as a method that is almost as effective as the male condom--at least when it comes to pregnancy prevention. If the male partner withdraws before ejaculation every time a couple has vaginal intercourse, about 4% of couples will become pregnant over the course of a year. However, more realistic estimates of typical use indicate that about 18% of couples will become pregnant in a year using withdrawal. These rates are only slightly less effective than male condoms, which have perfect- and typical-use failure rates of 2% and 17% respectively.
I think it's important that they are reflecting on this method of pregnancy prevention, but the reasons that sex educators have been hesitant to promote it still stand. Obviously, withdrawal is not effective at all for preventing sexually transmitted infections, so that's a big factor.
Also, as some of you pointed out, the withdrawal method relies on good communication (and self-knowledge) on behalf of the male partner. He's got to know when he's close to orgasm, tell his partner, and pull out in time. The piece about communication is true about most methods, except maybe hormonal things that don't require the other partner to participate (like the pill, or shot, or IUD). But I think we can all agree that we want to promote communication around safer sex.
But this might be a useful method in low-resource situations. Obviously there might be couples who find this an adequate method, particularly if they are in a monogamous partnership where they have both been tested. But say we're talking about a situation where the two people don't have access to other pregnancy prevention methods, either because of money constraints or lack of access to clinics or other services. Teaching them this method would at least give them something to fall back on in terms of pregnancy prevention.
What this makes me realize is how limited we still are when it comes to safer sex technology. Condoms are really the only option out there for preventing STIs, while we have a variety of options for pregnancy prevention (including, it seems, withdrawal). I think a true comprehensive sex education curriculum could have useful teaching on withdrawal, the downsides and possible benefits, alongside other methods of STI and pregnancy prevention.
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But it's dependent on the guy being responsible enough to pull out at the right time and offers no protection against STDs. This study doesn't offer anything except more excuses not to use condoms and I don't think that's ever a good thing.
But say you're in a long-term committed partnership with a responsible partner and don't do well on hormonal birth control. Condoms are necessary for STD prevention, yes, but I'd rather not be stuck with either latex OR hormones from a strictly pregnancy-prevention standpoint.
Not that this is exactly new information, as TSMC pointed out.
In that case, you would do much better using sympto-thermal fertility awareness, which is about as effective as the pill, despite what government statistics say.
Now, I wouldn't trust a guy I hadn't been with for years to use withdrawal, but my husband and I have been monogamous for almost 20 years now. I have only rarely used birth control over the past 8 years, despite the fact that our average is 5-6 times per week. I am convinced the reason that I have not become pregnant is that he only comes inside me about half the time, and I use the calendar to know when the safest times are for that. He doesn't have to wait till the last moment to pull out. As he gets close, he can pull out and I can get him off in other ways. Of course, he can return the favor. Why is intercourse the be-all and end-all that must end with the man ejaculating inside the woman?
The reason I like withdrawal is that it's hormone-free, it doesn't have the nasty taste or numbing effects of spermicides (they make your mouth numb--what are they doing to your vagina and clitoris?), I don't want to use condoms (that's one of the benefits of a longterm, faithful relationship and I'm going to enjoy it), it doesn't interrupt the moment, and I like to watch him reach orgasm, so it's a turn-on. (Who says women aren't visual?)
As for those who use condoms, I've never understood the "hard to open" line. When we use one, I open it and put it on him. I've never had the slightest problem opening one or getting it on him quickly.
That's where the trust issue comes in. Many men are responsible enough to do this. In fact, I'd say that most men are. I think that some men not knowing their bodies well enough would be more an issue than responsibility, personally.
Sex educators have known about the effectiveness of withdrawal for quite some time. It maintains its bad reputation because we're hesitant to recommend it, especially to young people, who are the target audience of most sex ed presentations.
Withdrawal requires a great amount of both self control and knowledge about your own body. Men do not all ejaculate at the same time - some ejaculate during orgasm, some before, and some after. Withdrawal is therefore more risky for younger men who might not have had enough experience to be able to time it right, and also might not understand (or care about) the gravity of the consequences of unprotected sex enough to be trusted to pull out in time....that whole teenage-invincibility thing. And, as letigreinfrance noted, there's no protection against STIs.
That being said, withdrawal combined WITH a condom is a pretty damn solid pregnancy prevention combo, even if you're not using another form of birth control.
I can speak only from my experiences. We've used the withdrawal method, and it's worked for us. That said, I completely agree with TheSoyMilkConspiracy that it requires significant self-knowledge on the part of the male. When we were younger, we used condoms and birth control pills. Now that I can't take anything hormonal, we sometimes use condoms and sometimes use withdrawal (until we get the all clear from the vasectomy!).
That said, we're not concerned about STIs as we're both tested regularly. Beyond that, we are at a point that we could welcome another child if I were to get pregnant. I don't know that it's something I'd do if I knew I wouldn't be able to care for a child if I were to get pregnant. I also can't imagine ever trusting anyone else enough to use it with him.
"Over half of these respondents reported problems with condoms including reduced sexual pleasure, inconvenience, and difficulty using them."
This quote in conjunction with the typical failure use rates for both withdrawal and condoms I find troubling. 17% typical failure rate?
Granted, "reduced sexual pleasure" is often one of the most heard complaints about condoms, but part of me thinks its because many men and women buy products they've heard of before - and Trojan condoms are probably the most prolific advertisers of male condoms (at least in my experience). The only problem is Trojan condoms are about as thick as dentist gloves and feel like you're making love through an industrial garbage bag. Lifestyles condoms are super thin, and once we made the switch, my boyfriend never complained about decreased pleasure again.
Inconvenience? You can buy condoms at just about any drug store or gas station in the country. Not to mention on-line (usually with a nice price break). Throw them in your bedside table and you're set until you run out. I don't see that as very inconvenient.
"Difficulty using them" was the line that got me. Yes, I can relate to the Seinfeld episode where George asks rhetorically why condoms are so hard to open, but beyond that, I don't see anything difficult about them! Squeeze the tip to prevent an air bubble and roll down. Maybe the inability to use condoms correctly accounts for the high typical use failure rate, but I've only ever had a condom break only once (and it was a Trojan!)...
Maybe we need better outreach on condom use? They're a cheap and easy method AND offer protection against STI's as well as pregnancy.
I think inconvenience refers to stopping to put one on, not the inconvenience of buying them. I've known men who've had a difficult time keeping an erection while putting one on - probably a mental issue, but still I can understand why there's that complaint.
I've always found the difficulty using them as funny because they're so obvious, but I've seen that before many times.
A lot of guys I know have difficulty keeping an erection while putting a condom on, including me. If you're not exactly nimble - definitely me - then even getting the damned thing on can be problematic, because of course you're trying to do it quickly so you don't lose the moment, but also making sure it goes on correctly. It can be difficult - there's times when I've been so psyched out about the condom that it ruined the whole encounter for both me and my partner.
Yeah in my experience it's guys that are worried about losing their erection while waiting a little while to put on the condom that actually will lose their erection. (And those that already view the condom negatively) If a guy doesn't worry about it then it usually doesn't happen. I think trying to put the condom on as fast as possible is a great way to mess up...
Also, I feel like having the other partner put it on for you might take away some of the tension?
I dont get that? When I'm horny (dont mean to be so frank) it would be bloody impossible to injure that via any non-hormonal birth control method. I dont understand how that would be any different with a guy? I mean, whats going through his mind? I find it a bit weird. Luckily I've never had that happen to me with a guy.
Try having your partner put the condom on for you, it normally prevents guys from losing arousal.
Julia and SilverAeris: yeah, having your partner put the condom on helps A LOT - it took me a while to figure this out, though.
Gopher: I'm not sure of exactly what happens, but I can tell you it's not because the guy stops being horny. Apparently, there's not a direct correlation between being horny and being able to maintain an erection - there's some third factor that can affect it, like anxiety. A doctor could probably give more info than me on this, though.
If it's very difficult for you to put on a condom, you should look at whether the condom is appropriately, uh, sized for you. Before I first had sex, I got some condoms and conducted a few trial runs of getting them on, which was (essentially) impossible. I read an article in a magazine (that suggested if you couldn't insert your erect penis in a toilet paper cardboard tube without getting a lot of papercuts, you should probably use large-sized condoms for a better fit. (Proper fitting increases the effectiveness too, but the difference in the ease of getting them on is enormous). (The same applies for condoms designed to be narrower with respect to effectiveness. I'm also lead to believe there are companies that do much better fits than just "Skinny, Regular, Large", but I don't know much about it.
My partner would often have some issue maintaining an erection while we applied the condom too. It still happens very rarely. We were able to fix the problem through good communication and using different more "fun" methods of condom application. I guess depending on your situation with your partner this type of practice and discussion might not be so easy. Also, I'd agree with the commenter who said that certain types of condoms might make for a less pleasurable sexual experience than other types. Again, this took some experimentation to find the right one (which might be easier in some situations than in others). And while condoms aren't terribly expensive or hard to locate, that expense still might be a burden for some couples. At one point we were strapped for cash and couldn't afford to buy condoms for a while so we went to the local health department to get some for free. While it's a good service and I appreciate that it's available at no cost, they didn't really give out the "good" ones. Yeah, they worked in the sense that they didn't break or anything, but they didn't make for the best sexual experience (they were the thicker ones :( )
I'm pretty interested in checking out this study in greater detail. Both my partner and I are in a committed relationship and we've both been tested and neither of us have any STIs. I like the experience of fluid bonding, but I don't like being on the pill so this may work for us.
You know what's REALLY inconvenient? Unplanned, unwanted pregnancies and STI's.
Then again, I'm in college, so the "inconvenience" line just screams lazy frat boy who doesn't want to use a condom to me.
I said it before and I'll say it again. I've never met a man I would trust that much.
Dear Wiccaman, I hope someday you'll meet a man you can trust that much. There are definitely trustworthy men in this world. I've used withdrawal in long term relationships only and it never failed. STDs and STIs weren't a concern, so the method was perfect. But I always used condoms with short-term partners.
I agree with previous posters that young men in particular may have a difficult time with this method and should absolutely use condoms.
Just seems to me that withdrawal places a lot of trust on the male. I've met lots of women whose "partners" have done a disappearing act when a baby came along. I think it's wonderful if there are some men that can be trusted in that regard, but it's a lot easier for a man to walk away from an unintended pregnancy than for a woman.
I haven't read anything about the study in question; however, the failure rate for withdrawal is highly dependent upon self-control at a time when other things may be on one's mind. From my university days, I recall reading of failure rates of between 4 and 30% (lots of room for error).
On the other hand, I know men who are way more worried about avoiding any pregnancy than women are. If a woman gets pregnant she can choose an abortion but if a man gets her pregnant its out of his hands.
I still wouldn't use this method unless I was in a long term monogamous relationship (and had Plan B on hand in case the guy forgot when he was in the moment).
Well I think it depends on the male's sensitivity, because I tried about 10 brands with my bf before I got the IUD and he said they all felt about the same.
There are other kinds of failure with condoms too, besides what's mentioned. We had one get stuck when my bf pulled out, and he was still hard, but I was a little too dry and the latex just stayed inside me. Nothing is 100%.
Lube has become the answer to many of my condom woes.
That has its own "inconvenience factor" as well, because I can't leave it in my car and I don't want to carry it in my purse. Spur-of-the-moment sex doesn't happen as easily, especially if I'm not at home.
When I was younger, I thought that it was really weird and off-putting to have to stop and say, "I need some lube, hold on a sec." When it came down to it though, I realized I was either going to get some more lube and have a good time, or I was going to risk a broken condom and have sore genitals for a couple days. He got over it and 've never questioned myself about it since. I almost always have to use extra lubrication once or twice during sex.
With all that being said, I beleive that withdrawel could be reasonable for me and my boyfriend, but I prefer to use a condom and my hormonal method. Peace of mind I guess.
Moist makes itty bitty lube containers that attach to a keychain.
Great news, if one is in a completely and utterly monogamous relationship as or with a man and both parties have been comprehensively tested, and come out clean. Like with hormonal contraception in heterosexual couples.
That being said, most of us have ourselves or know somebody who's been around the block too many times to fall for the "it doesn't feel as good" thing. The 'discomfort' and 'inconvenience' of condoms can't begin to compare to AIDS or even non-life-threatening STDs like herpes.
My parents used withdrawal successfully for more than 20 years--this is after 2 unplanned pregnancies, one with a diaphragm and one with an IUD. I am contraindicated for hormonal birth control and my spouse is allergic to spermicide. Both of us hate condoms. Interspersed with having 2 planned kids, we used withdrawal successfully for many years in combination with fertility awareness, but I have to confess that I did ultimately become pregnant. However, I think the pregnancy was caused by my miscalculation (I ovulated early). He's a beautiful boy!
I find the backlash to the withdrawal method offensive to my right as a woman to make informed choices about my body and my sexuality.
My partner and I have been using the withdrawal method for years now without incident. Like all methods of birth control, it isn't perfect and it isn't right for everyone, but people that choose this method are often treated like they lack intelligence or are engaging in risky behavior.
Thank you for posting this study.
I think it goes back to when sex ed is taught for the first time and this method is mentioned for the first time. If you're speaking to a middle/high school class about this stuff, the last thing that you want to do is seem like you are giving students permission to do this, especially when the withdrawl method is mentioned. Perhaps health teachers of whatever sort feel the kids shouldn't be having sex because they have so much going for them, etc and this only increases the risk of screwing up the future, or something of the sort. I don't mean to sound all-knowing or better than anyone. I'm all for everyone having a safe, satisfying, healthy sex life by all means possible.
My sex ed teacher (comprehensive sex ed in 1988/89) actually has us write "dummy method" as a description of the withdrawal method. She said that we (all-girls school) would be fools to trust a boy to pull out at the moment his pleasure was most intense.
To be honest, I can see why an adult would tell a room full of 14-year-old girls that. Teenage boys probably aren't the most reliable people around with regards to their sexual response and self-control.
I do agree that it stigmatizes adults who use this method, though.
When teaching younger children about contraception, I still think this should still be referred to as the "pull and pray" method. Maybe not as demeaning, but we don't need more unintended pregnancies. The risks associated with this method, whether it be STDs/HIV/AIDS and/or unintended pregnancy, should be emphasized. Yes, some teenagers will have sex, and some will have unprotected sex anyway. I remember in sex ed and health class we were taught about this method but only really about its low chances of preventing a pregnancy and STDs/HIV-AIDS. I don't know. When making a decision to have sex, there should be major emphasis on responsibility. The lack of accountability and responsibility in society may be the reason why we have so many issues. Who's respobsibility is it to teach about responsibility? Responsible adults.
/speech.
lol. Something like that.
If you call it pull and pray, what about all those kids who have been taught that "prayer works, its been medically proven!" (If you haven't seen Saved!, its a great movie).
When making a decision to have sex, there should be major emphasis on responsibility. The lack of accountability and responsibility in society may be the reason why we have so many issues. Who's respobsibility is it to teach about responsibility? Responsible adults.
I agree. But I also don't see anything responsible about withholding information about a method of birth control that, for all intents and purposes, is effective. I definitely think the problems with withdrawal (no STI prevention, relies on an incredible amount of willpower and knowledge of the body that teenagers often don't have) should be acknowledged, but that doesn't mean it should be universally disregarded or its failure rates exaggerated.
Exactly. Why is lying a good idea? The pill has its drawbacks (no STI prevention there, folks, and let's not even get into the health risks), yet we don't refuse to acknowledge it or belittle people who use it. I used the pill as a highly-active, non-smoking teenager, and it gave me horrible lower leg pain. That is an indication that heart attack and stroke could be on the horizon. Is that a good risk for a 15-year-old? When I stopped taking the pill, those problems went away. In short, the pill could have killed me when I was still quite young. Why is that an acceptable risk and a method that everyone should know about, but withdrawal (which we have used with great success and NO health risks) isn't?
I'll stick to the traditional family method of hopping on one foot while thinking of Jesus. It was taught to me by my mother, and who known more about it than a woman with fifteen kids?
17% failure rate (over one year)?
That is exactly the odds for russian roulette.
As the article pointed out, those are roughly the same failure rates as condoms. And the 17% applies to typical use, not perfect use. Perfect use means you use your method of birth control according to the instructions consistently every single time you have sex. So if a person was only using condoms every other time they had sex (or weren't checking the package for holes or the expiration dates), they would not be demonstrating "perfect use," which would obviously up their risk of failure. A person who fails to withdraw in time, or who only manages to withdraw some of the time, would also not be a "perfect" user of withdrawal.
It's important to remember that the method itself accounts for only part of the failure rate. Being diligent about using your method correctly also has a significant impact on its effectiveness. Being a perfect user of withdrawal is less risky than being a typical user of condoms or other forms of birth control (only in terms of pregnancy prevention - not STI prevention.)
I hate condoms, I hate hormones being injecting into me or taken orally or through a patch, I hate spermicide creams, and I hate IUD's. My boyfriend and I are strictly withdrawal, we've both been tested, and it's fantastic, he and I are immensely careful and so far, so good.
Don't have sex, because you will get pregnant and die.
On a serious note, withdrawal also hasn't been encouraged as a birth control method because of pre-cum/pre-ejaculate, which cleanses the urethra before ejaculation. It's harder, if not impossible, to determine when that's happening. It can contain traces of sperm. So the risk isn't astronomical, but the risk is still there.
That's my concern also. I wonder if there are any studies or such on the risk of pre-cum making you pregnant if pull out is used.
If a man hasn't ejaculated recently before, then pre-cum will not contain sperm. Pre-cum comes out of a different place than sperm. This is a relatively new finding, but I think it's been known for at least a few years. It just hasn't been publicized much.
Here's a link to research done on this topic: http://www.springerlink.com/content/l51735386n53u261/
Interesting! Thanks for the link.
Yes, thanks for the link! :)
What constitutes "recently?" A day or two? Before urination? Does it make sense that urination would flush out any sperm in the urethra? I have no idea...
That's exactly what I was wondering about. Sure, there's not much sperm in pre-come, but the chance is there.
I don't think it's so much the amount of sperm in pre-cum, but the amount of left over sperm in the urethra already that comes out with the pre-cum...
I totally understand why you wouldn't want to endorse this method in an 8th grade health class. For me and my partner, though, it's officially the bee's knees. He has a latex allergy, and I have interstitial cystitis, which for me means I don't do well with either condoms or hormonal birth control. Add to this that the only unintended pregnancy (and miscarriage) I've had was while on the pill, and that I'm the only gal I know who hasn't had someone leave a condom inside of her, it continues to seem like a pretty appealing solution. With that said, I may feel differently if I weren't married (to someone who can handle the "perfect use" model) and monogamous. Although a 4% chance of pregnancy is still a bit high for my taste, I am not in a situation where an error would mean a crisis. Of all of our options, we feel this is the best at this time.
Wouldnt that mean that the condom was too big?
In a word: "yes".
However, you should probably figure men in the field know little to nothing about condom sizes, and figure that even if they did, many would rather risk pregnancy and STDs (or anything else you can imagine) than admit they need a smaller condom.
I have used withdrawal successfully for fifteen years with three different male partners with whom I was in long-term, monogamous relationships.
I'm sure I had the same experience as many of you in school in the 90s who were taught that withdrawal would absolutely get you pregnant. That "pre-cum" was just the same as ejaculate. Despite this, I used withdrawal with my partner for several years, and never got pregnant. Now I'm married and use hormonal birth control - because withdrawal is not fun for either of us.
You know what else I remember learning in "sex ed"?
"What do you call a couple using the rhythm method? Parents."
Such brainwashing and misinformation we were subjected to!
My boyfriend and I have been practicing withdrawal for years. We know the statistics and made a conscious, educated decision to use this method after other hormonal/barrier methods didn't work for us. Yet people still think nothing of outright mocking me for making this choice. It's totally rude and insensitive.
I'm genuinely sorry to hear that. It just proves that education on the subject is clearly not as profound as it should be. After reading the comments here, I'm still not sure who's side I am on concerning when, to whom, and how this information should be dealt out.
During the first four months of my relationship, my partner and I used condoms and withdrawal about equally, and for the past two months we have been using withdrawal because I haven't been able to refill my birth control prescription (Planned Parenthood has been booked solid every single day I've tried to make an appointment, it's truly insane). We haven't used condoms since those first four months and it's been almost two years. This is because we're in a long-term, monogamous relationship, we've both been comprehensively tested, and he knows when to withdraw.
I wouldn't condone this method among teenage couples, or couples who aren't monogamous, or men who can't tell when they actually ejaculate in time to withdraw successfully every single time.
I can't wait to get back on birth control though. Even though I generally trust the withdrawal method, I feel more comfortable just taking a low-hormone birth control pill.
Thanks for posting the pre-cum study link, YouCan2! I didn't know that.
I'm a big fan of giving honest, reliable information to kids, and it's sad that this is yet another issue that they've been lied to and mislead about. However, I could understand how many teens (who may not have the benefit of being in touch with their bodies and are more likely to downplay their risks of STI infection would use this and put themselves at risk for infection or pregnancy. I don't think that omitting or providing inaccurate information is a way to prevent the problem though.
Perhaps if adults start giving teens good solid information and being honest with them about ALL of their options and the consequences of using those options they'd be more likely to believe what they are being taught. If they know that they are being lied to about so many different issues then they may not feel like they are getting honest answers about risks. If they know that a lot of what they are being told is false, then why wouldn't they think that risks and negative outcomes were simply manufactured by those in authority roles to keep them from doing something they want to do?
I wonder how couples plan simultaneous orgasms using this method? If she's cumming I think pulling his dick out at the moment he's coming and she's cumming would be disruptive to my (ie, woman) orgasm.
The only time I've ever seen a simultaneous orgasm was in the movies.
This happened with me once. I was left extremely unsatisfied.
also, wouldnt that hurt? When your vaginal muscles are contracting impulsively and gripping the penis, pulling it out quickly would be disruptive.
If by disruptive you mean painful, I guess (for me at least, I can't speak for anyone else) that it depends on how wet the woman is.
--and to Kathleen6674, I have yet to witness a real-life simultanteous orgasm too, but that doesn't mean it doesn't happen. I guess I imagine thinks like tantric sex and breathing exercises and whatnot. Like, being comletely and utterly in tune with your own and your partner's bodies.
I don't think not coming at the same time has anything with being out of "tune" with your body or that of your partner. It has to do with how aroused you are and some facts about biology. The female orgasm is caused by uterine contractions. These contractions cause the cervix to dip into the vagina in a rhythmic way. The purpose is to dip into the pool of semen that has already been ejaculated into the vagina. In short, the biological purpose of the female orgasm (just like that of the male) is the aid in conception. In essence, women generally take longer to come than men because their orgasms are "meant" to take advantage of what the male orgasm has already deposited. Of course, women don't have to come to get pregnant because the sperm can swim. However, their orgasms make conception far easier.
That doesn't mean that all women take longer to come. I generally find that I come very quickly or not at all. That's true a good 90% of the time for me. There are plenty of times, though, when I don't reach a climax until after my husband is finished. I'm just fortunate that he has no respect for what he considers to be the selfishness of most men when it comes to spending the time to satisfy a woman.
I was taught in health class that one drop is enough to cause a pregnancy.