Does the withdrawal method really work? A doctor is here to debunk the myth.

I’m always surprised by how many couples tell me their main method of contraception is pulling out.

The oldest form of contraception used by humankind, ‘coitus interruptus’, is the practice of having sex without a condom and pulling the penis out of the vagina just prior to ejaculation.

It’s built on the theory that sperm isn’t emitted from the penis before orgasm – but this isn’t entirely true.

Some couples swear by the ‘withdrawal method’ and are massive advocates because it’s worked for them in the past. Which is lucky, because I’ve spoken with many couples who have relied on the withdrawal method and unexpectedly fallen pregnant.

The withdrawal method works well… until it doesn’t.

Real world data shows that pulling out is effective 78 per cent of the time. This means that if 100 fertile heterosexual couples have sex regularly and use only the withdrawal method as contraception, then 22 of them will become pregnant over a 12-month period.

Putting it another way, nearly one in four couples find out the hard way that the withdrawal method didn’t work. As a doctor who talks about contraception regularly with my patients, I don’t like those odds.

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Unrealistic expectations of the withdrawal method’s effectiveness can lead to a pregnancy blame-game. Men are often accused of being caught up in the moment, not pulling out fast enough, or not caring when it comes to cumming.

Contraception methods
"Nearly one in four couples find out the hard way that the withdrawal method didn’t work." Image: Getty.

But we forget that sperm are incredibly sneaky. Nature often finds a way of foiling our best intentions by ensuring procreation.

Throughout human history, couples have had their coitus interrupted due to many different reasons. Whether it was an enemy hiding in the bushes or a knock on the bedroom door, passionate embraces frequently finish before coming close to a happy ending - but despite these brief encounters, people can still fall pregnant.

Instead of sexual partners blaming each other, it’s time to blame pre-cum.

Pulling out would work much better if it wasn’t for pre-ejaculate - the slightly viscous, glistening emission that appears at the tip of an aroused penis.

Some blokes produce copious amounts of pre-cum, while others only produce a tiny drop. The more foreplay you have, the more heated up he gets, and the more pre-cum you’re likely to enjoy.

Pre-ejaculate is created in the bulbourethral glands (cowper’s glands) that sit just beneath the prostate. The liquid is rich in nutrients that help keep sperm alive, and it makes up roughly 5 per cent of the total ejaculate volume.

As the bulbourethral glands are anatomically distant from the testicles, it would seem unlikely for sperm to be present in pre-cum, but to quote Jurassic Park, “life finds a way”.

Contraception
"Instead of sexual partners blaming each other, it’s time to blame pre-cum." Image: Getty.

A study was published in Human Fertility (Cambridge) in March 2011, titled ‘sperm content of pre-ejaculatory fluid’, where 27 participants were awkwardly asked to provide both pre-cum and full ejaculate samples. The final results showed that 37 per cent of the pre-cum samples contained live sperm at concentrations similar to their full load.

Participants also provided pre-cum samples on different days and this revealed a fascinating observation. Men who had sperm in their initial pre-cum sample had sperm in all of their subsequent pre-cum samples, but those men who didn’t have any sperm in their initial pre-cum sample continued to not have sperm in all of their subsequent samples. Those in the latter category weren’t infertile as they all had sperm identified in their full ejaculate.

This research suggests that the men who consistently have no sperm in their pre-cum might be able to use the withdrawal method as a reliable form of contraception. This could explain why there are many couples who have successfully used the withdrawal method, but also many pregnant couples who say it’s rubbish.

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Which leads us to the obvious question, how can you tell which group your partner belongs in? How can you tell if pre-cum contains sperm?

Semen analysis is frequently performed on full ejaculate samples as part of a fertility test. Pre-cum could theoretically be examined in the same way, but unless it’s for research purposes the lab will only be interested in the full sample.

Sperm may either be present or absent in the secretions from the cowper’s glands and hypothetically, this could be used to decide if the withdrawal method is likely to work all the time - but I wouldn’t recommend it.

Only 27 people were tested in the study, so we can’t presume that every pre-cum sample will be consistent. “Life finds a way”, so sperm may intermittently find a way of sneaking out. A pre-cum semen analysis would only be able to tell you that the withdrawal method may work for you…until it doesn’t.

Condom
"It’s worthwhile using a condom if you or your partner have multiple partners." Image: Getty.

And of course the only contraception that protects against sexually transmitted infections is a condom, so it’s worthwhile using them if you or your partner have multiple partners.

So what are the lessons learnt from today? Sperm are sneaky. The withdrawal method works well for some couples, until it doesn’t. Make sure a condom is put on before things get too exciting, and make sure pre-cum doesn’t get near the vagina.

Remember that contraceptive pills, injections, implants, intra-uterine devices (IUDs), tubal ligation, and vasectomy are all proven to be more effective than the withdrawal method.

You don’t need to play reverse Russian roulette with a penis, so speak with your doctor about the right contraception for you.

Brad McKay is an Australian doctor, television personality and author.

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