Coitus interruptus, also known as withdrawal or the pull out method, is a method of contraception in which, during sexual intercourse, the man removes his penis from the woman's vagina just before he ejaculates. That way, the emission of semen is not in the vagina but elsewhere. This method has been widely used for at least 2,000 years and was used by an estimated 38 million couples worldwide in 1991.
Effectiveness
Like many methods of birth control, reliable effectiveness is achieved only by correct and consistent use. Among couples who use withdrawal as their sole method of birth control, but do not use it consistently or correctly ("typical use"), there is a 27% per year failure rate. However, for the couples that use this method correctly at every act of intercourse, the failure rate is 4% per year. In comparison the pill has a typical use failure rate of 8%, which drops to about 0.3% if used correctly, while the diaphragm has a typical use failure rate of 16% and a perfect use failure rate of 6%.
Used by itself, coitus interruptus is unreliable, because of the difficulty of controlling the process of ejaculation. The primary cause of failure of this method of contraception is the lack of self-control of those using it: interrupting just at climax can be psychologically difficult, as it goes against the natural instinct to ejaculate deeply within the vagina. In addition to failure to withdraw, poor timing of the withdrawal can result in semen on the vulva, which can easily migrate into the female reproductive tract.
It has been suggested that the pre-ejaculate ("Cowper's fluid"), fluid emitted by the penis prior to ejaculation, contains spermatozoa (sperm cells), and is easily drawn into the vagina by capillary action. However, several small studies have failed to find any viable sperm in the fluid. While no large conclusive studies have been done, it is now believed the primary cause of method failure is the pre-ejaculate fluid picking up sperm from a previous ejaculation. For this reason, it is recommended that users of withdrawal have the male partner urinate between ejaculations, to clear the urethra of sperm, and wash any ejaculate from objects that might come near the woman's vulva (e.g. hands and his penis).
Advantages
The advantage of coitus interruptus is that it can be used by people who have religious objections against or do not have access to other forms of contraception. It has no monetary cost, requires no artificial devices, has no physical side effects, and can be practiced without a prescription or medical consultation.
Disadvantages
The difficulty of using the method correctly makes it a poor choice of birth control for many couples. Even when it is practiced correctly, it can be frustrating for the couple, interrupting and ending intercourse just as they are about to experience the physical and psychological pleasure of the man's orgasm within the woman's vagina.
Withdrawal is also largely ineffective in the prevention of STDs, since pre-ejaculate may carry viral particles or bacteria which may infect the partner should the fluid come in contact with mucous membranes. However, a reduction in the volume of bodily fluids exchanged during intercourse may reduce the likelihood of disease transmission due to the smaller number of pathogens present.
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