The SMSNA periodically receives and publishes ‘guest editorials.’ The current article was submitted by Mia Barnes, a freelance writer and researcher who specializes in women's health, wellness, and healthy living. She is the Founder and Editor-in-Chief of Body+Mind Magazine.
Practicing safe sex is essential. Everyone deserves protection against unwanted pregnancies, but making informed decisions without learning if a contraceptive method is effective is challenging. Discover if the pull-out method actually works and whether you should switch to an alternative form of contraceptives.
What Is the Pull-Out Method?
People use the pull-out method to prevent sperm from reaching an ovulated egg. When the partner capable of ejaculation is close to orgasm, they pull their penis out of their partner’s vagina before it occurs.
Does the Pull-Out Method Work?
The American College of Obstetricians and Gynecologists (ACOG) found that the pull-out or withdrawal method isn’t highly effective. If 100 women use only the pull-out method, 22 will become pregnant1 within those 12 months. A 22% failure rate means withdrawal is 78% effective, which can become even lower depending on the ovulating person’s monthly cycle. In comparison, condoms are tested to be 98% effective and birth control pills are 99% effective.
How the Ovulation Cycle Works
When you begin your monthly period cycle during puberty, your ovaries start to ovulate. They release an ovum — also known as an egg — between days 11 and 14,2 which remains in the uterus until it sheds its lining to start the person’s period.
Potential Risks of Pulling Out
It may seem like timing the ovulation cycle and pulling out are straightforward, but there are a few potential risks to consider. These are the primary concerns for anyone relying solely on this birth control method.
1. Ejaculation May Happen Too Quickly
Pulling out requires perfect timing. If the partner about to ejaculate doesn’t withdraw from the vagina fast enough, some or all of the semen may remain in the vaginal canal. Early orgasms can also occur. Research shows 20%-30% of cisgender men3 experience premature ejaculation regularly.
2. Sperm Can Exist in Pre-Ejaculate Matter
Although there’s limited research on semen in pre-ejaculate fluid, it’s generally known that it can leak in during sexual intercourse. The most recent studies are from 2010 and 2016, so more updated research is necessary.
However, the 2010 study found that 41% of participants4 had semen in their pre-ejaculate fluids. The 2016 study found the same results in 17% of participants5 within a larger group of cisgender men. Since this fluid is present from the beginning of an erection, the risk remains throughout intercourse.
3. Ovulation Doesn’t Always Happen on Schedule
Experts conducted a study of over 600,000 cisgender women and found only 13% of participants6 had regular menstrual cycles. The rest had cycles that were shorter or longer than 28 days. This irregularity can make ovulation occur earlier or later in the month.
Accidental fertilization is more likely when someone is timing their ovulation doesn’t have consistent 28-day menstrual cycles. Having unprotected intercourse on the wrong day, experiencing premature ejaculation or accidentally not withdrawing fast enough could fertilize an egg that the woman doesn’t know is in her uterus.
Alternatives to Pulling Out
People depending on the withdrawal method may choose to do so because getting a hormonal birth control prescription is too expensive. Their bodies might not respond well to these contraceptives.
Other forms of birth control don’t have to require hormones or prescriptions. Partners who can get pregnant can also consider using condoms, a silicone diaphragm, a copper IUD or spermicide gel. The efficacy rates will vary with each option, so it’s crucial to research alternatives before trying them.
Make Informed Safe Sex Decisions
The pull-out method may work occasionally, but its effectiveness varies based on the people involved, timing and a bit of luck. Researching every available contraceptive option is the best way to make an informed decision about preventing unwanted pregnancies.
You can also call your primary care physician to discuss birth control possibilities more specifically. The doctor can consult your health history before recommending the best path forward.
The American College of Obstetricians and Gynecologists. (n.d.). Effectiveness of Birth Control Methods. ACOG. https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods
When Does Ovulation Occur?. UPMC HealthBeat. (2023, May 8). https://share.upmc.com/2023/01/when-does-ovulation-occur/
Raveendran, A. V., & Agarwal, A. (2021, January 25). Premature Ejaculation - Current Concepts in the Management: A Narrative Review. International Journal of Reproductive Biomedicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851481/
Killick, S., Leary, C., Trussell, J., & Guthrie, K. (2010, December 15). Sperm Content of Pre-Ejaculatory Fluid. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.3109/14647273.2010.520798
Kovavisarach, E., Lorthanawanich, S., & Muangsamran, P. (2016). Presence of Sperm in Pre-Ejaculatory Fluid of Healthy Males. Thai Science. https://www.thaiscience.info/journals/Article/JMAT/10986029.pdf
Bull, J. R., Rowland, S. P., Scherwitzl, E. B., Scherwitzl, R., Danielsson, K. G., & Harper, J. (2019, August 27). Real-World Menstrual Cycle Characteristics of More Than 600,000 Menstrual Cycles. Nature News. https://www.nature.com/articles/s41746-019-0152-7