Understanding the withdrawal method

THE scientific term for it is “coitus interruptus”, but it is better known as the “withdrawal method” — that curious birth control method for the swift and the brave, and which has been practised by many active couples worldwide at some point in their life.

It is said that withdrawal could very well be the world’s oldest way of preventing an unwanted pregnancy. According to experts at Planned Parenthood, about 35 million couples worldwide rely on withdrawal.

Consultant obstetrician/gynaecologist at Gynae Associates, Dr Mandi Elliot, explains that in order to as accurately as possible practise this method, which involves a man pulling his penis out of his partner’s vagina just before he ejaculates, the woman must first know the length of her menstrual cycle.

“This means the number of days from day one of one period to day one of the next. Once that number is regular, that is, the same or very similar every month, she can assume the five days before and five days after her menses are ‘safe’. This method should not be used if the cycle length is longer than 32 or shorter than 26. Alternatively, most smartphones have apps which can calculate safe days. If you are still unsure, consult your OBGYN,” she advises.

This method is suitable for couples who are against other types of birth control for reasons such as religion, living in regions of the world with limited access to contraceptives, or being allergic to all other methods of contraception, although that’s highly unlikely, the doctor says.

The withdrawal method has no side-effects but it is important to remember that it is not foolproof and does not protect against sexually transmitted diseases.

“Personally, I call patients who use this method ‘soon-to-be parents’. To be candid, I’ve found it to be most often used in one-night stands or when condoms aren’t available or ‘liked’. Efficacy is very important when choosing a method of birth control,” Dr Elliot stated.

She pointed out that the method has a failure rate of 15-28 per cent per year, meaning that it is highly unreliable and leads to many unplanned pregnancies.

“So it’s definitely not ideal for long or short-term use. Pulling out works in principle, but it is challenging to pull out just right every single time. However, it is better than no method at all,” the gynaecologist said,

A woman and her partner need to fully understand and appreciate how this birth control method works before they attempt to try it, as it is not simply a matter of pulling out at the point of ejaculation. It is almost a science.

“It takes experience, practice, and lots of self-control to be effective. It requires significant self-control. Men must be able to predict when they are reaching the point when ejaculation can’t be stopped or postponed,” she said.

Even done correctly, there is a failure rate.

“If done correctly, four women will become pregnant out of every 100 women who use this method. When not always done correctly, 27 out of every 100 women who use this method will become pregnant,” she informed.

The failure rate is high due to the fact that whilst pulling out just before ejaculation is the target, sperm can still be present in ‘pre-cum’ which is the fluid a man produces once he is aroused. This fluid is often emitted long before he ejaculates, Dr Elliot stresses.

Despite the risk, this method does have its benefits compared to hormonal or medical birth control methods. There are no hormonal side-effects as can occur with the pill, injection, and the patch, among others.

Dr Elliot points out too that, “It is also convenient as no prescription or purchase is necessary, and it’s free”.

However, the withdrawal method is ranked as the least reliable method, and Dr Elliot says that for this reason she definitely does not recommend it. Furthermore it is not recommended for men who suffer from premature ejaculation or are sexually inexperienced.

Also, the psychological drawback to the sexual experience as constantly having to ensure that the man withdraws in time “can lead to unsatisfactory sex”.

Emphasising a few tips for couples who decide that “coitus interruptus” is a the preferred method for them, Dr Elliot says it is very important to:

1. Know your STD status and be aware of your partner’s status too;

2. Keep emergency contraception on hand;

3. Practise with a condom if it is your first time trying this method;

4. Ensure that the man knows when he is about to ejaculate and test if he can pull out in time;

5. If you plan to have sex again within a short period of time, the man should urinate first and clean the tip of his penis to remove any remaining sperm.

“Take home message? If you’re not going to be fine with getting pregnant, a more reliable method of birth control is needed,” Dr Elliot insists.