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Choosing a Birth Control Method

(Published September 2009)

Withdrawal

Description. The penis is withdrawn from the vagina before ejaculation occurs.

Use. In withdrawal, the man withdraws his penis from the woman’s vagina before he climaxes and ejaculates. The practice requires the man to be able to recognize when he is about to ejaculate and to withdraw the penis from the vagina and away from the woman’s external genitalia in time. Withdrawal is often used by couples as a backup method to condoms or hormonal methods.62

WithdrawalEffectiveness. This method is effective. The pregnancy rate of this method appears to be similar to that of the male condom—approximately 4% with perfect use and 18% with typical use.62 There is no evidence to support the common belief that preejaculate fluid contains sperm.63

Risks and Side Effects. None.

Advantages

  • Readily available
  • No cost
  • No advance planning necessary

Disadvantages

  • Requires cooperation and self-control of male partner
  • Lower efficacy than some other methods with typical use
  • Required with every act of intercourse
  • Lack of protection against STIs

Counseling Messages.Withdrawal can be part of a larger risk-reduction strategy when used with hormonal, barrier, or other methods. Although not as effective as some contraceptive methods, it is substantially more effective than not using a method at all. Withdrawal can be discussed as a legitimate, if slightly less effective, contraceptive method just as condoms and diaphragms are. Counsel women who rely on withdrawal to protect themselves against STIs. Encourage patients to obtain EC in advance; provide a prescription if the patient is less than 17 years old.