Is the Pull Out Method Safe?

For lots of people contraception is a tricky subject. It's not surprising then, that some couples rely on the withdrawal or pull-out method, also known as coitus interruptus. According to the WHO, 47millon women worldwide use this method. In 2008 in the UK 3.9 % of all contraceptive users were using the withdrawal method.

What is the withdrawal method?

Withdrawal or “pulling out” is exactly what it sounds like – the man removes his penis from his partner’s vagina and genital area before he ejaculates. In theory, this should prevent pregnancy as it stops his sperm from entering her vagina. In practice, however, the withdrawal method can be pretty unreliable, which is why it’s not advised as a reliable or standalone method of contraception by the NHS.

Perfect use of this method would mean:

• Pulling out before ejaculation every time you have sex
• Ejaculating outside the vagina and away from the genitals.

Remember: Sperm are mobile and can find their way into the vagina even if the ejaculation happened "outside". In one survey, 41% of women ages 18 to 24 reported practicing withdrawal and researchers estimate the actual number could be higher.

How effective is the withdrawal method?

Statistics about withdrawal method effectiveness will vary depending on who you ask. However, it’s all about technique. If you don’t pull out quickly enough, or if some sperm still gets into the vagina, there’s going to be a risk of pregnancy. Planned Parenthood recommends that with perfect use, withdrawal is effective in preventing pregnancy about 96% of the time. For every 100 people who use it perfectly, there will be four pregnancies.

However, going by typical use, it’s a different story:

• On average, 22 out of 100 couples will become pregnant from relying on the withdrawal method
• Roughly one in five people will become pregnant

The withdrawal method works best when you are in a long-term relationship and if both partners are equally keen to avoid pregnancy. It can’t really be recommended when you are having casual sex - condoms would be ideal here as they also protect you against STIs.

Contraceptive Effectiveness Comparison

• Combined pill: 99% effective
• Male condoms: 98% effective
• Withdrawal (perfect use): 96% effective

One reason why withdrawal isn’t 100% effective – even with perfect technique – is that sperm can be released even before ejaculation. This “pre-ejaculate” or “pre-cum” contains sperm, which is why it can cause pregnancy. Because of this, if you experience premature ejaculation the pull-out method is not advisable.

Does pulling out protect against STIs?

No, pulling out doesn’t stop you catching an STI. Some STIs like herpes and genital warts are spread through skin-to-skin contact. While others like chlamydia can be spread in pre-cum. The best way to prevent STIs is using condoms for penetrative and oral sex. This is why it’s not recommended in any situations where you aren’t sure of your partner’s STI status.

Benefits of the pull-out method

Although the pull-out method isn’t reliable, many people use it for a range of reasons, including:

• Religious or philosophical
• It's a non-hormonal method
• There are no side effects
• It’s too late to use another method
• They don’t have sex often
• They wouldn’t mind if they got pregnant

Having said this, the withdrawal method is still better than nothing. So if you don't have reliable contraception when you’re in the moment, it is an option.

Should I use the pull-out method?

The NHS doesn’t recommend withdrawal as contraception; it’s much more likely to lead to pregnancy than tried and tested methods like the pill. Dr Neel Patel explains: "The pull-out method is not a reliable or recommended method of contraception. It has a higher failure rate than other forms of birth control. Even if perfectly done (which is rare), it is thought to be only 96% effective, lower than other methods. And before using this method, you should have an open conversation with your sexual partner."