coitus interruptus

Coitus interruptus, also known as withdrawal or the pull-out method, is a technique in which a man withdraws his penis prior to ejaculation during sexual intercourse, with the semen being ejaculated outside of and away from the vagina.

It is and has been widely used for at least 2,000 years as a method of contraception. This method was used by an estimated 38 million couples worldwide in 1991.^[1] Some medical professionals view withdrawal as an ineffective method of birth control.^[2]

History

Perhaps the oldest documentation of the use of the withdrawal method to avoid pregnancy is the story of Onan in the Hebrew Bible. This text is believed to have been written down over 2,500 years ago.^[3] Societies in the ancient civilizations of Greece and Rome preferred small families and are known to have practiced a variety of birth control methods.^[4]:12,16-17 There are references that have led historians to believe withdrawal was sometimes used as birth control.^[5] However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries, and ineffective, such as amulets).^[4]:17,23

After the decline of the Roman Empire in the 400s, contraceptive practices fell out of use in Europe; the use of contraceptive pessaries, for example, is not documented again until the fifteenth century. If withdrawal were used during the Roman Empire, knowledge of the practice may have been lost during its decline.^[4]:33,42 A contributing factor to the loss of contraceptive knowledge was the rise of Christianity, which considered all forms of birth control to be sins.^[4]:35,37

From the eighteenth century until the development of modern methods, withdrawal was one of the most popular methods of birth control in Europe, America, and elsewhere.^[5]

Effectiveness

Like many methods of birth control, reliable effectiveness is achieved only by correct and consistent use. Observed failure rates of withdrawal vary depending on the population being studied: studies have found actual failure rates of 15-28% per year.^[6] In comparison, the pill has an actual use failure rate of 2-8%,^[7] while the intrauterine device (IUD) has an actual use failure rate of 0.8%.^[8] The condom has an actual use failure rate of 10-18%.^[6] However some authors suggest that actual effectiveness of withdrawal could be similar to effectiveness of condoms, and this area needs further research.^[9] (see Comparison of birth control methods)

For couples that use coitus interruptus correctly at every act of intercourse, the failure rate is 4% per year. In comparison the pill has a perfect-use failure rate of 0.3%, and the IUD has a perfect-use failure rate of 0.6%. The condom has a perfect-use failure rate of 2%.^[8]

The primary cause of failure of the withdrawal method is the lack of self-control of those using it. Poor timing of the withdrawal can result in semen on the vulva, which can easily migrate into the female reproductive tract. Some medical professionals view withdrawal as an ineffective method of birth control.^[2] In contrast, a recent study in Iran found that provinces with higher rates of withdrawal use do not have higher fertility rates, and that the contribution of withdrawal use to unintended pregnancies is not markedly different from that of other commonly used methods such as the pill or condom.^[10]

It has been suggested that the pre-ejaculate ("Cowper's fluid") emitted by the penis prior to ejaculation normally contains spermatozoa (sperm cells), which would compromise the effectiveness of the method.^[11][12] However, several small studies^{[13][14][15][16]} 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 (correct-use) failure is the pre-ejaculate fluid picking up sperm from a previous ejaculation.^[17] 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 penis).^[18]

Advantages

The advantage of coitus interruptus is that it can be used by people who have objections to or do not have access to other forms of contraception. (Some men prefer it so they can avoid possible adverse effects of hormonal contraceptives on their partners.^[19]) Some women also prefer this method over hormonal contraception to avoid adverse effects such as depression, mood swings, vaginal dryness, decreased libido, and headaches, among others. It has no direct monetary cost, requires no artificial devices, has no physical side effects, can be practiced without a prescription or medical consultation, and provides no barriers to stimulation.

Disadvantages

Compared to the other common reversible methods of contraception such as IUDs, hormonal contraceptives and male condoms, coitus interruptus is less effective at preventing pregnancy.^[8] As a result, it is also less cost-effective than many more effective methods: although the method itself has little direct cost, users have a greater chance of incurring the risks and expenses of pregnancy and child-birth. Only models that assume all couples practise perfect use of the method find cost savings associated with the choice of withdrawal as a birth control method.^[20]

The method is largely ineffective in the prevention of STDs, like HIV, since pre-ejaculate may carry viral particles or bacteria which may infect the partner if this fluid comes in contact with mucous membranes. However, a reduction in the volume of bodily fluids exchanged during intercourse may reduce the likelihood of disease transmission compared to using no method due to the smaller number of pathogens present.^[15]

The method may be difficult for some couples to use. The interruption of intercourse may leave some couples sexually frustrated or dissatisfied.^[21]

Masters and Johnson considered withdrawal as a means to developing sexual problems, e.g. premature ejaculation.^[22] The same opinion was shared by Polish sexologist, Kazimierz Imieliński.^[23] However neither of those authors refers to any scientific research on this topic, there could not be found any research to backup those theories^[24], and health risks connected with withdrawal are considered as myths.^[25]

Prevalence

Worldwide, 3% of women of childbearing age rely on withdrawal as their primary method of contraception. Regional popularity of the method varies widely, from a low of 1% on the African continent to 16% in Western Asia. (Data from surveys during the late 1990s).^[26]

In the United States, studies have indicated 56% of women of reproductive age have had a partner use withdrawal. In 2002, 2.5% were using withdrawal as their primary method of contraception.^[27]

References

Further reading

• Jones RK, Fennell J, Higgins JA, Blanchard K (June 2009). "Better than nothing or savvy risk-reduction practice? The importance of withdrawal" (PDF). Contraception 79 (6): 407–10. doi:10.1016/j.contraception.2008.12.008. PMID 19442773. http://www.guttmacher.org/pubs/journals/reprints/Contraception79-407-410.pdf. Retrieved 2009-07-23. 

See also

• Coitus reservatus
• Cum shot
• Onanism