Withdrawal Contraceptive Method

• What is the withdrawal contraceptive method?
• How does the withdrawal contraceptive method work?
• When to and when not to use the withdrawal method
• Who uses the withdrawal method?
• Important points about the withdrawal method
• How to use the withdrawal method
• Effectiveness of the withdrawal method
• Benefits of the withdrawal method
• Limitations of the withdrawal method

What is the withdrawal contraceptive method?

Withdrawal is a contraceptive method in which the male partner interrupts intercourse, so that he can withdraw his penis from his partner’s vagina prior to ejaculation. It is also known as coitus interruptus or simply as "pulling out". Withdrawal is a natural family planning method which can be used as a primary or back up method (e.g. couples using fertility awareness methods of family planning may use withdrawal as a back up method during fertile times of the menstrual cycle).

Withdrawal has been used for centuries, in most societies of the world. While it is much less effective than many modern contraceptive methods, it provides considerable contraceptive protection compared to not using contraceptives at all.

How does the withdrawal contraceptive method work?

The withdrawal contraceptive method works by preventing sperm entering the woman’s uterus. It therefore prevents sperm coming into contact with an oocyte and thus prevents fertilisation.

When to and when not to use the withdrawal method

All women who have a willing partner can use withdrawal as a contraceptive method. There are no medical conditions which contraindicate use of this method by men, although there are some men who may find the method more difficult to use than others. These include:

• Men who experience premature ejaculation; and
• Men who find it difficult to identify when they are about to ejaculate (for example, sexually inexperienced men).

Who uses the withdrawal method?

The Sex in Australia survey, a national survey of sexual behaviours and experiences, reported that 4.5% of Australian women rely on withdrawal for contraceptive protection. This is lower than the global prevalence of withdrawal use (6%), and the prevalence in other developed countries (e.g. in Canada 9% of all women and 22% of 15-17 year olds use withdrawal for contraceptive protection).

In Australia, women from non-English speaking backgrounds, and those with a non-cohabiting, regular sexual partner were significantly more likely to use the withdrawal method than English speaking women, or those in other types of sexual partnerships. Use was less common amongst those living in regional, compared to those living in urban and remote areas. Use of withdrawal amongst Australian women was not significantly associated with their age, level of education, income, or occupational type.

Important points about the withdrawal method

Individuals considering using the withdrawal method should be aware of other, more effective contraceptive methods including hormonal (e.g. the hormonal contraceptive pill or injection), barrier (e.g. male condoms and female condoms) and other natural family planning (e.g. Basal body temperature monitoring). A general practitioner or family planning clinic will be able to provide the necessary information about the benefits and limitations of each of these methods.

As the withdrawal method is highly dependent on the male partner’s ability and willingness to interrupt intercourse and withdraw his penis prior to ejaculation, women considering using this method should discuss their choice with their partner. Wherever possible, both partners should attend a family planning clinic or GP’s office together, to jointly discuss their contraceptive options. The couple should consider realistically their ability to use the method, in particular whether or not the male partner has the capacity to withdraw prior to ejaculation during every act of intercourse. Couples may wish to consider using another form of contraception in the early stages to allow the man to practice and become more used to withdrawing prior to ejaculation.

How to use the withdrawal method

It is important to understand the following points on how to use the withdrawal method:

• The male sexual partner should withdraw his penis from the female partner’s vagina when he feels like he is about to ejaculate;
• He should also ensure that his penis is away from the woman’s external genital area before ejaculating;
• After ejaculation, the man should urinate before having sex again. Urinating helps wash away any sperm which may remain in his penis;
• Emergency contraceptives should be used if the method fails (i.e. if the male partner does not withdraw his penis prior to ejaculation). Emergency contraceptives are available over the counter from Australian pharmacies, and can be used effectively for several days, and not just the morning after unprotected intercourse. Couples who do not have easy access to a pharmacy (e.g. those living in remote areas) may which to keep emergency contraceptives on hand, just in case they are needed;
• Patients wishing to protect themselves against sexually transmitted infections (STI) should use male or female condoms as the withdrawal method does not protect against STIs.

Effectiveness of the withdrawal method

When used properly, the withdrawal method is 96% effective. It is however highly user-dependent, that is, it is highly dependent on the ability of the male partner to correctly identify when he is about to ejaculate, so that he can withdraw his penis prior to ejaculation. This may be difficult for some men, for example young men with limited sexual experience and men who experience premature ejaculation. In practice withdrawal protects women against pregnancy in 73% of cases.

While this is considerably lower than highly effective modern methods of contraception (e.g. combined oral contraceptive pills are >99% effective), withdrawal offers considerable contraceptive protection when compared to no contraceptive use at all. An estimated 85% of women will become pregnant within a year when no contraception is used, compared to only 27% of women who use withdrawal.

Benefits of the withdrawal method

The benefits of the withdrawal method include:

• It is a natural method which has no side effects;
• It is available to all couples, all the time, as either a primary or backup method;
• It doesn’t cost anything;
• It promotes male responsibility for contraceptive protection and may encourage couples to communicate; and
• Learning to control ejaculation may make men more aware of their sexual sensations and help them to manage premature ejaculation.

Limitations of the withdrawal method

The limitations of the withdrawal method include:

• It is one of the least effective contraceptive methods;
• It requires high levels of self control from the male partner; and
• It may interfere with sexual pleasure.

 

More information 

For more information on different types of contraception, male and female anatomy and related health issues, see Contraception.

References

1. World Health Organisation. Family Planning: A global handbook for providers. 2007. [cited 2009, June 20] Available from:  www.who.int/entity/reproductivehealth/publications/family_planning/en/
2. Bissell, M. Withdrawal: historical, current and cultural perspectives on its use. Canadian J Human Sexuality. 2003;12. [cited 2009, July 29], available from: http://www.accessmylibrary.com/coms2/summary_0286-12839304_ITM
3. Germano, E. Jenning, V. New approaches to fertility awareness based methods: incorporating the standard days and two days methods into practice. J Midwifery Women’s Health. 2006;51:471-7.
4. Richters, J. Grulich, A.E. de Visser, R.O. et al. Sex in Australia: Contraceptive Practices in a representative sample of women. Aust NZ J Pub Health. 2003;27:210-6.
5. Callabretto, H. Emergency contraception- knowledge and attitudes in a group of Australian university students. Aust NZ J Public Health. 2009;33(3):234-9.
6. International Planned Parenting Federation. Withdrawal. 2009. [cited 2009, July 4]. Available from: http://www.ippf.org/en/Resources/Contraception/Contraception.htm