The withdrawal method, or “pulling out,” is a common birth control practice. This method involves the male partner withdrawing their penis from the vagina before ejaculation occurs. Despite its widespread use, its reliability in preventing pregnancy is a frequent concern.
Why Withdrawal Carries Pregnancy Risk
Pregnancy is possible with the withdrawal method, primarily due to pre-ejaculate fluid and challenges with precise timing. Pre-ejaculate, or “pre-cum,” is a clear fluid released from the penis during sexual arousal, prior to full ejaculation. This fluid can contain sperm. Studies have shown viable sperm can be present in pre-ejaculatory fluid, with some research indicating its presence in up to 41% of samples from healthy men.
Beyond sperm in pre-ejaculate, human error plays a significant role in the method’s reduced effectiveness. Successfully withdrawing requires considerable self-control and accurate timing, which can be challenging during sexual activity. This difficulty often leads to withdrawal occurring too late or some ejaculate inadvertently reaching the vagina or vulva.
Failure rates highlight the withdrawal method’s limitations as a standalone contraceptive. With typical use, about 20 out of every 100 individuals who rely on withdrawal will become pregnant within one year. Even with perfect use, where withdrawal occurs correctly and consistently every time, the method is about 96% effective, meaning approximately 4 out of 100 individuals will still experience a pregnancy within a year. These rates indicate withdrawal is considerably less effective than many other available birth control options.
What to Do After Unprotected Sex
If the withdrawal method was used and pregnancy is a concern, emergency contraception (EC) is a viable option. EC prevents pregnancy after unprotected sex or contraceptive failure, with highest effectiveness the sooner it is used. There are two main types of emergency contraception: emergency contraceptive pills (often called the “morning-after pill”) and the copper intrauterine device (IUD).
Emergency contraceptive pills primarily delay or inhibit ovulation, preventing egg release. These pills are available in formulations like levonorgestrel (e.g., Plan B One-Step) or ulipristal acetate (e.g., Ella). Levonorgestrel pills are most effective within 72 hours (3 days) of unprotected sex, though usable up to 5 days. Ulipristal acetate pills are effective for up to 5 days (120 hours). Some levonorgestrel pills are available over-the-counter without a prescription at pharmacies, while ulipristal acetate typically requires a prescription.
The copper IUD is the most effective form of emergency contraception, preventing over 99% of pregnancies when inserted by a healthcare provider within 5 days of unprotected sex. It works by creating a chemical change that affects sperm and eggs, preventing fertilization and implantation. Unlike pills, a copper IUD can also serve as a long-term birth control method for many years after its emergency insertion. Emergency contraception should not be considered a regular birth control method.
Planning for Future Contraception
For those seeking to prevent future unintended pregnancies, exploring more reliable birth control methods is important. Various highly effective options exist that do not rely on real-time decision-making during sex, significantly reducing pregnancy risk. These methods are categorized into hormonal, long-acting reversible contraception (LARC), and barrier methods.
Hormonal methods include birth control pills, patches, and vaginal rings, which typically contain estrogen and progestin to prevent ovulation. When used correctly, these methods are highly effective, with typical-use failure rates ranging from 7% for pills, rings, and patches to less than 1% for perfect use. Long-acting reversible contraceptives (LARCs), such as IUDs and implants, are among the most effective reversible options available. IUDs (hormonal and copper) and implants are inserted by a healthcare provider, preventing pregnancy for several years with over 99% effectiveness. Their effectiveness is not dependent on daily user action, making typical-use failure rates almost identical to perfect-use rates.
Barrier methods, such as condoms, diaphragms, and cervical caps, work by physically blocking sperm from reaching an egg. While male condoms have a typical-use failure rate of about 13%, they are also the only method offering protection against sexually transmitted infections (STIs). Combining barrier methods with hormonal methods can provide dual protection against both pregnancy and STIs. Consulting a healthcare provider is recommended to discuss individual health factors, preferences, and lifestyle, ensuring selection of the most suitable and effective contraceptive method.