Parenting

Skepchick’s Guide to the Uterus: Pullin’ out in style!

It has come to my attention that some of the old stand-by advice on coitus interruptus, aka the “withdrawal method” or “pulling out”, is, quite possibly, all bullshit.

Naked On Roller SkatesFor years, dare I say decades, sex ed classes and conventional wisdom have been teaching us that pulling-out is barely more effective at preventing pregnancy than leaving-in. Turns out, pulling out is the next best thing to actually using a condom! Honest to FSM!

The Guttmacher institute took  a look at the evidence for the widely held belief that withdrawal is a useless form of contraception. What they found is alarming in light of what we’ve always “known”! Pulling out has a 4% failure rate when used perfectly and 18% failure rate when used imperfectly. I know 18% seems high, but remember that’s only when used not-quite-right… maybe the couple is using it most of the time (or just some of the time) or maybe Mr. Loverpantsless doesn’t see any flaws in his “one squirt won’t hurt” policy.

Regardless of how it may be used wrong, when compared to condoms, puller-outers hold their own… or, um, don’t. Condoms have a perfect-use failure rate of 2% and an imperfect-use failure rate of 17%, according to the figures in the study. So, comparatively, bareback fares pretty well.

FAM_SIGN-EMERGENCY_EXIT_9X12-6071Of course, this doesn’t mean that condoms will become obsolete at the “hands” of those opting for the equally effective, but free luxuries of the last-minute retreat. Condoms are still the only birth control method that stops the spread of disease.  Doingitus interruptus still puts its users at risk of HIV and other sex juice borne infections. So there’s no need to panic that kids are going to be running around, listening to the rock’n’roll, going all Paradise by the Dashboard Lights without dashboard insurance since there’s no need for condoms anymore. There is a need, and the need is a huge one. /*That’s what she said.*/ And it still needs to be stressed by parents and sex-educators.

But for those of you who are in long-term, committed, monogamous relationships where the male half can show some restraint, who are looking for a cheap and easy hormone-free form of birth-control or are looking for a temporary fix between birth control methods, you don’t need to worry about a condom budget.

As a bonus, if you’re looking for some ideas to add a little spice, check out urbandictionary.com. It’s the largest internet resource of ejaculate maneuvers. Be sure to look up all your favorite super-heroes… unless you’re at work. Seriously, don’t look up anything at urban dictionary while you’re at work… or sober… or feeling especially sentimental about your self-respect.

Let’s break it down:

Pros

  • Free
  • No planning required
  • Comparable to condoms in efficacy
  • Pharmacists cannot deny you (professionally)
  • None of the cons of using condoms
  • Money shots

Cons

  • Does not protect against disease
  • Requires the most self-control of any birth control method
  • Does not come in flavored or glow-in-the-dark varieties

So there you go! Withdrawal is no longer the shameful disgusting act of the ill-prepared and promiscuous. It is now a legitimate way to avoid pregnancy.

Since I’m still enjoying those pills I mentioned in my last post, right now a completely inappropriate version of the Hokey Pokey comes to mind… but I’ll spare you.

Enjoy your weekends!

Elyse

Elyse MoFo Anders is the bad ass behind forming the Women Thinking, inc and the superhero who launched the Hug Me! I'm Vaccinated campaign as well as podcaster emeritus, writer, slacktivist extraordinaire, cancer survivor and sometimes runs marathons for charity. You probably think she's awesome so you follow her on twitter.

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61 Comments

  1. Yeah, but what I save in money spent on condoms I have to spend on Shamwows.

    BTW “one squirt won’t hurt” is pure genius and should find it’s way imedeately onto a tshirt in the Skepchick store

  2. I’d still not let a single study convince me of this, not when I know pre-ejaculate has sperm in it and not when I know the urge to keep the penis in is so high. Then again, I don’t have to worry about pregnancy with my partners, one is surgically sterilized and the other doesn’t have a uterus.

  3. @ballookey exactly.

    The thing that worries me, despite its possible benefits is that the cons can have really serious consequences (I’m mostly thinking STIs, but babies as well…). And while I would love to think that everyone who is having sex is open and willing to discuss contraception, a lot of people are not which makes it even harder to insure that pulling out actually happens.

    My other worry is that word gets out that withdrawal is almost as effective as condoms and them guys start refusing to use them and…problems ensue.

    And after reading the Jones et al. it seems like the study is suggesting that further study needs to be done about the effectiveness of withdrawal and how it is reported in other studies of sexual behavior and isn’t all that definitive.

  4. The Oneida sect in the mid-19th c. practiced coitus interruptus and coitus reservatus (no ejaculation) as birth control.
    I remember one of my professors saying that after these techniques were established, there were only two births in the sect, which was ultimately its downfall. I googled a bit, but couldn’t find anything to back up my recollection. Still thought it might be interesting.

    Oh, and I second the “One Squirt Won’t Hurt” shirt.

  5. Just where are these sex-ed classes that teach that withdrawl is a useless form of contraception? I was always told it was better than nothing but due to pre-ejaculate, it is not a reliable method. Now I’m to believe its more reliable than we thought?

  6. @mikekoz68: That’s what I heard too – if you’ve got nothing else available, better to pull out than stay in, but condoms are still the wiser choice, especially for teenagers, who may not yet have enough knowledge of their own response to get the timing right.

  7. What kind of superhumans are these withdrawers? I mean, you start sticking it in and sperm comes out, and then she bitches about it not being satisfying. There’s no room on that timeline for “withdrawal”. Or is that just me?

  8. I think the “if used properly” caveat combined with the “requires self-control” part is a pretty serious con. Outside of a controlled study, many would probably use it improperly or, more likely, not at all even if they’d decided to.
    At least I know that I personally have next to no self-control at the best of times and the passionate throes of the sexin’ is unlikely to exactly improve it.
    I think it would be interesting to see a study on how often people could use it properly (compared to other methods). But I can’t even begin to imagine how such a study should be set up … :~D

  9. To me, pregnancy is too important to not deliberately use something reliable, and more reliable than withdrawal. I have never not used reliable birth control except when trying to conceive a child. No one I have had sex with has ever gotten pregnant except when we were trying to conceive a baby.

    I looked at the paper, and the research on the reliability of the method isn’t very good. I did find this abstract of an article.

    http://www.questia.com/googleScholar.qst?docId=5006614102

    I think the point of what the woman was saying is that withdrawal was “our” method; it was a method that her partner had to take an active role in. My presumption is that if he didn’t take that active role, then he wouldn’t be her partner any more. Using withdrawal was a way for her to tell how committed he was to her as a long term significant other and not just as a sex partner.

  10. Many people combine condoms with the pill, so in that light, I wish to share with you all that I have only once simultaneously combined a condom with the withdrawal method.

    I have been banned from that credit union ever since.

  11. Would’t the ‘If performed properly’ the biggest caveats though?
    I mean, if you the focus only focusses on the few cases when it is performed correctly, you automatically not even consider most of the failures…

  12. Yes.

    But, let’s say you have a thousand users of both.
    (Warning, some made up numbers to follow).

    Let’s assume that you have a 50% rate of people using condoms incorrectly.
    That’s a 500 X 2% = 10 + 500 x 17% = 85 =>95 unwanted pregnancies total.

    Let’s assume that you have 90% people not pulling out in time.
    That’s a 100 x 4% = 4 + 900 x 18% = 162
    => 162 unwanted pregnancies total.

    But I have not read the article in question, it might be mentioned somewhere.

  13. @daedalus2u: “No one I have had sex with has ever gotten pregnant except when we were trying to conceive a baby. ”

    I need to add something: You can still do everything right and get pregnant. Birth control (except abstinence) is never 100%. Ever.

  14. @Simon39759:

    My advice to the people who aren’t able to pull out in time is to use a different form of birth control.

    That is also my advice for people who can’t remember their pills, rip condoms or are allergic to spermicidal jelly.

  15. @daedalus2u:

    I think you only read the intro to that article, not the article itself, and not the beginning of the last paragraph (which is cut off in the middle unless I want to pay for it):

    Dr. John Guillebaud (1999), in his book Contraception: Your Questions Answered, tells us that the use of withdrawal has been associated with some of the lowest birth rates in history, for example in Eastern Europe after the Second World War.

    I think that’s the part where they go on to talk about more stuff other than a girl who really likes her boyfriend.

    Also, I don’t think pulling out is a good long-term strategy. I don’t think condoms are either. However it’s more cost effective than any other method (except the unreliable rhythm method, which is also free… until you get pregnant), and that’s not insignificant. If you can’t afford other forms of birth control you have an option.

    That’s all it is – an option. I’m not demanding that everyone give up all other forms of BC.

    It’s also not for everyone. And I never said it was. No one method of birth control is right for everyone. It’s up to you to decide whether it’s what you want to do. In fact, that’s the whole point of this series about birth control… it all started with Skepchicks talking behind the scenes about our successes and failures with different forms of BC.

    Is it just my hangover causing me to read too much into things or do people seem strangely hostile to the suggestion that maybe withdrawal isn’t such a bad thing?

  16. marilove, you are correct, but when two or more methods are used correctly, the chances of failure become quite low. For me, that has usually been condom plus spermicide. I have had condoms fail, but never has anyone gotten pregnant. I am a parent, so I know I am fertile.

    Combining perfect use of male condom and perfect use of spermicide (justified because I do use them that way), the perfect use failure rate is 3% and 6% respectively. That makes a combined failure rate of 0.0018%. That is an average of 1 pregnancy every 556 years.

    I completely agree with Elyse, if you can’t use a birth control method effectively enough, then you should use another method, including abstinence. But abstinence is only effective when used perfectly. When used imperfectly (as is the usual case), it has very low effectiveness.

  17. Elyse, you are right, I did only read the intro, I didn’t want to pay for the whole article either. I don’t dispute that withdrawal can be an effective birth control method in a committed relationship. I think that promoting it is like promoting abstinence-only. A method that works if it is used perfectly, but used imperfectly is very likely to be ineffective.

    You are right, I am somewhat hostile to withdrawal. My objection to promoting withdrawal is that teens will use it instead of more effective methods (i.e. male condom) when they first become sexually active and while not in committed relationships where both partners are committed to each other and to the relationship and will support each other if the woman becomes pregnant. My suspicion is that many teen boys will not use withdrawal perfectly and teen females will end up pregnant and single mothers because the teen boys are not yet capable of being responsible parents.

    Many women don’t have sufficient power in a relationship to compel her partner to use a male condom. I see that as a problem of women not having sufficient control over their own bodies and I don’t like the idea of giving teen boys (or even adult men) another excuse as to why they don’t need to wear a condom. As you point out, it doesn’t prevent STD transmission.

  18. I see the same problems with this as with abstinence only – human error. At least in abstinence only, it requires both partners to give in in the heat of the moment. With this method, it’s pretty much all up to the guy, unless the woman has an impeccable sense of observation and timing, and can overcome the logistics.

    I also think it appropriate to add the cleanup factor to the “CON” list. That reservoir tip can be damn convenient.

  19. @daedalus2u:

    The advice that I’m giving is for adults. Adults in long-term monogamous relationships. Not for teens.

    I agree that teens shouldn’t be encouraged to rely on withdrawal. But to deny them the information is pretty unfair, don’t you think? The attitude that we can’t teach teens about X because then they’ll do it is exactly the illogic that the abstinence-only folk cling to and wave around as a scare tactic.

    It’s important for teens to know that it is a viable option when others are not available. It’s also important that they are informed of the risks and other things to consider when deciding to forgo other forms of birth control.

    The reality is that people don’t get another sex-ed later when they become responsible adults. We get it as kids and we get it as teens. It’s not useless to teach high school aged kids about IUDs or vasectomies, is it? Isn’t it worth it to at least offer them the information?

    The current teaching is that withdrawal is useless. So once you’ve already given into temptation, there’s no real reason to stop… you’re not really reducing your chances of anything happening. By not teaching kids about the benefits of pulling out, you’re putting them at greater risk of pregnancy… they’re ALREADY having unprotected sex.

    By saying “this works”, you’re not saying “this works and it’s the best option”… you’re just saying it’s one option. One with risks. There’s a very real chance that you’re going to screw up, especially with long-term use. There’s no protection against disease, either. You seem to think that kids don’t care about not getting AIDS or syphilis… they do.

    Condoms must be stressed in any good sex ed program. Condoms always unless you are certain you are in a monogamous relationship with a person you are sure is disease free. Expecting that everyone is going to do that is just as naive as expecting them not to have sex at all.

    (I apologize if I’m rambling and repeating myself… my brain seems to be taking the day off)

  20. This is interesting, and I have anecdotal confirmation for this “method,” but I find it irresponsible to suggest that it is a real “method” at all….

    It’s almost like, sure, your statistical chances of pregnancy are lower, that’s a little obvious… However, this isn’t a safer sex practice at all…

    I know it’s been mentioned that this really should apply to people who are in stable relationships… but I believe this complete lack of trying to prevent pregnancy should be reserved to couples who should fully expect and be fully prepared (financially and emotionally) to become pregnant…

    I don’t know… it makes me anxious to suggest anything to the contrary of “this is NOT a form of birth control.”

    It’s as close to being a form of birth control as the “rhythm method” is.

    I won’t even bother going into how terrifying is to consider infection risks.

  21. Elyse, another method is always available, that of abstinence until another method is available. The problem of abstinence only is that it requires waiting until procreation is desired and then never having sex unless procreation is wanted.

    It really isn’t too much to ask for people who think they are responsible enough to have sex and deal with the consequences including becoming parents to not use a more reliable form of birth control than withdrawal.

    I think it is really not a good idea to give teens the idea they can use withdrawal “if nothing else is available”. They can be abstinent, they can use oral or manual stimulation. There are plenty of ways they can be sexually active without risking pregnancy. That is what should be encouraged, not a method that is pretty unreliable.

    The religious right will object to withdrawal too. That is the sin of Onan, spilling his seed on the ground.

    http://www.skepticsannotatedbible.com/gen/38.html

    but it is more complicated than that.

  22. @daedalus2u: spermicide is BAD! bad bad bad. it is very irritating to our sensitive bits. irritating can increase the chance of STDs. many women are allergic to it (i am — it HURTS).

    there are other methods. spermacide, ugh ugh ugh

    the best bet is to use hormonal birth control (if you can), along with condoms — and lube. lube and condoms go hand in hand.

  23. @marilove:

    I’m going to forgo my usual quip about the “hand in hand” comment, except to say (in my best Butthead voice):
    Huh-huh huh, you said hand, lube, and condoms in a single sentence, huh-huh.

    Ok, I lied- that IS my usual quip.

  24. @daedalus2u:

    It’s not too much to ask. But the masses are going to say no.

    It’s not going to happen. Just because YOU were able to always use birth control and never give into temptation when it wasn’t available doesn’t mean that’s the reality for everyone. And when it does happen, people have the right to be armed with as much information as possible to avoid worst-case-scenarios.

    You seem to not understand the difference between “this is a good option” and “this is not recommended and should be avoided if possible, but here’s a backup plan”.

    You also don’t seem to get it that people are already having unprotected sex. You can ask them politely, or not so politely, to stop… in fact, they’ve already been told plenty that they they never should have done it in the first place… but I’m going to put every last dime I own on “no matter how much you ask, they don’t stop”.

  25. Elyse, I don’t think we disagree very much. My concern is that the information won’t be used responsibly, but will be used as an excuse to not use condoms. If the information on the relative effectiveness was included in comprehensive sex ed that covered “everything”, including stuff about respecting women, then I wouldn’t object. If women had sufficient power in their relationships with their partners to freely choose such things without duress, then I wouldn’t object.

    If the information was limited to “abstinence-only, but if you can’t hold out, then withdrawal works almost as good as a condom” then I think it would be worse than no information. I fully expect conservatives to try and do exactly that.

    I went to a talk about microbicides for prevention of STD transmission, primarily to try and prevent HIV. This was a talk to raise awareness primarily in the gay community and to get feedback on what people thought about it, what they wanted, what they were looking for. It was kind of surprising to me how many people wanted really badly to stop using condoms. I think it was an eye-opener for the researchers too (judging from their body language). The people wanted the researchers to say “this will be as good or better than a condom, so you can stop using condoms”. Every single one of the researchers knew that no topical antimicrobial agent is ever going to be as good as a condom. If a topical antimicrobial agent causes people to switch from condoms to the topical antimicrobial it will increase the transmission of HIV.

    This is what I am concerned about, not that teens will use withdrawal instead of nothing, but that they will use withdrawal instead of condoms. If that happens, then pregnancy and STDs will both go up.

  26. @Elyse:

    Oh, yes.. I just mentioned that at the end as an afterthought about the notion of people being less afraid of doing this act. Because, I think the main motivation for condom use is probably reluctance to become pregnant, than worry over getting a disease.. that’s just a guess….

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