How Effective Is Withdrawal at Preventing Pregnancy?

My girlfriend and I have been having sex for about five months, and I’ve used a condom about three times out of all the times we’ve had sex. I must be really good at pulling out because she isn’t pregnant yet. What are the chances she gets pregnant if we keep this up?

People sometimes attach moral judgments or fear to particular methods of birth control that have nothing to do with how effective they are. For instance, the extremely effective and safe IUD is widely used in some European countries and in China, but is much less popular in the United States  probably due to our collective cultural memories of IUD-related complications and lawsuits in the 1970s that are unrelated to IUDs in use today. Similarly, for most of my career as a sexuality educator, using withdrawal or the pull-out method—which involves removing the penis from the vagina before ejaculation—has been frowned upon and rarely discussed as a legitimate method of contraception, despite the fact that it can be quite effective if done correctly.

I think that the main reason that sex educators have traditionally shied away from discussing withdrawal is that the effectiveness of this method is completely dependent on men’s self-awareness, self-control and commitment to avoiding pregnancy, and women have to place a lot of trust in their male partners if this is the only type of contraception being used (it also provides no protection against sexually transmitted infections, but this is true of many other methods of birth control as well). When done correctly every time they have sex (e.g. a man always pulls his penis out of the vagina before ejaculation begins), about four out of every 100 couples using withdrawal will become pregnant over the course of a year. If not always done correctly (which is usually considered “typical use” or a more realistic estimate of effectiveness, since no one is perfect), about 27 out of every 100 couples using withdrawal will become pregnant over the course of a year. As this chart shows, that’s in the same general range of effectiveness as the diaphragm, condoms and contraceptive sponges.

There’s a very big difference between “perfect” use and “typical” use, so, as you say, you have to be pretty good at pulling out in order to avoid pregnancy.  Some things that you can do to make pulling out more effective are:

·               Urinating before having sex to flush any sperm out of the urethra that might still be hanging out after a previous ejaculation.

·               Being very aware of your body’s sexual responsiveness and knowing when you are approaching ejaculation.

·               Not using this method when you are drunk or otherwise less attuned to your body’s sexual responses.

·               Pulling the penis completely out of the vagina before ejaculation and not ejaculating anywhere near the opening of the vagina or the vulva.

·               Using this method with another method like a condom or a contraceptive sponge.

Withdrawal is free, readily available to those who are committed to using it correctly, and has no side effects—all positives. If this is the only method that a couple has access to, it’s way better than doing nothing to prevent pregnancy. However, if pregnancy would be a personal disaster for you or your partner at this point in your life, you might want to consider more effective methods like an IUD or the pill.

Laura Anne Stuart owns the Tool Shed, an erotic boutique on Milwaukee’s East Side. She has a master’s degree in public health and has worked as a sexuality educator for more than fifteen years. Want Laura to answer your questions in SEXPress? Send them to laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.