Already today I’ve heard from a few people who have questions about a study recently published in the journal Contraception that suggests that pulling out (the withdrawal method of birth control) rivals condoms in terms of effectiveness in reducing pregnancy risk.
Before you accept that as a take-home message, though, let me share my thoughts about the study’s findings and how it applies to what people need to know about their sexual and reproductive health choices:
First, this is good quality research – no doubt about it. But let’s talk about the interpretation of the study. The issue here is the degree to which people use a birth control method (condoms vs. pulling out/withdrawal) correctly. Using the withdrawal method suggests that two people are having intercourse without using a condom and then depend on the man to pull his penis out of his partner’s vagina (hence “withdrawal”) prior to ejaculation. Some people worry that it’s risky due to the fact that pre-ejaculate will get inside a woman’s vagina anyway.
Yet pre-ejaculate itself doesn’t contain sperm (however, if a guy has recently ejaculated and not yet peed, then there is the chance that the pre-ejaculate could pick sperm up and carry them out of the body, which would be a pregnancy risk). However, assuming there are no sperm in a man’s urethra because he has recently peed after this last ejaculation, then there should be little to no risk of pregnancy occurring from pre-ejaculate which would make the withdrawal method – when used perfectly – a highly effective choice for pregnancy risk reduction.
Three issues though:
1) Many men cannot control the timing of their ejaculation (about 20-25% of men come very quickly and with little control). This would make the withdrawal method more challenging for them and thus their risk of pregnancy may be substantially higher.
2) The reason that the two are comparable is also because people don’t always use condoms correctly. Their “perfect use” effectiveness rate is high – it’s when people use them incorrectly that we see a higher risk for pregnancy or infection.
3) This article is about pregnancy risk only – not infection risk – so that’s important to note. Condoms offer protection against HIV, chlamydia and gonorrhea whereas the withdrawal method does not.
The bottom line is that this is a quality study and it adds to our understanding of birth control methods that people use, but couples should review their methods in the context of to what extent they can use a method in a way that is most effective. If a man has little ejaculatory control, then withdrawal will not be a solid option for them. Also, if a couple is concerned about infection risk, withdrawal is also not a recommended option for them. Condoms still have an important place in the reduction of pregnancy risk and infection risk.