Wednesday, May 20, 2009 4:44 PM UTC

Withdrawal method: Not an oxymoron?

Contraceptive researchers make a measured push for pulling out

Withdrawal method: Not an oxymoron?

This one, more or less, you’ve heard before:

Q. What do you call a guy who says, “Don’t worry, baby, I’ll pull out”?

A. A father.

Because we all know, of course, that coitus interruptus is pretty much the opposite of reliable contraception.

Or do we? In a commentary forthcoming in the June issue of Contraception (PDF), public health experts make the and-donkeys-fly suggestion — based on existing research showing it works better than you might think — that “the withdrawal method” should not necessarily be dismissed as an oxymoron. Here’s your did-you-know of the day: Based on typical-use failure rates, withdrawal is only slightly less effective than the condom at preventing pregnancy.

Of course, withdrawal does not protect against sexually transmitted infections (though the researchers urge further research there), so — if for that reason alone — sex educators have been reluctant to wave its flag as a contraceptive. “Reliance on withdrawal alone is inappropriate for certain high-risk populations,” acknowledges the report. However: “It is unfortunate that some couples do not realize they are substantially reducing their risk of pregnancy when using withdrawal, as these misperceptions may cause unnecessary levels of anxiety. More speculatively, if more people realized that correct and consistent use of withdrawal substantially reduced the risk of pregnancy, they might use it more effectively.”

That is, studies find that people rarely mention “withdrawal” when asked what they associate with the term “birth control.” If withdrawal were at least acknowledged as an actual method, if a flawed one, rather than a provisional Oops! and a prayer, people might take and use it more seriously — possibly to even better effect.

Especially today, the analysis goes. “Hormonal and long-acting contraceptive methods, such as the IUD, are the most effective means of preventing pregnancy,” says lead author Rachel Jones of the Guttmacher Institute. “However, these methods are not suitable for or available to all women. Also, we’re hearing anecdotally that because of the current economy, fewer women are able to afford these more effective methods, yet many cannot afford to have another child right now. For these couples, withdrawal may be a good backup option when used in conjunction with condoms. Withdrawal can provide ‘extra insurance’ against pregnancy for all couples, even those using hormonal methods. And withdrawal is far more effective at preventing pregnancy than use of no method at all.” (The study addresses withdrawal both alone and used in just-in-case conjunction with other methods.)

What’s the message here for sex educators? “Acknowledging the importance of withdrawal is crucial … for counseling women and men about pregnancy prevention and choice of contraceptive method,” the study says. “Practitioners should recognize that some of their patients may be relying on this method even if they do not report it. Although withdrawal may not be as effective as some contraceptive methods, it is substantially more effective than nothing. It is also convenient, requires no prior planning and there is no cost involved. Consistent dual use of withdrawal in conjunction with hormonal, barrier or other methods could constitute an effective contraceptive strategy. Health care providers and health educators should discuss withdrawal as a legitimate, if slightly less effective, contraceptive method in the same way they do condoms and diaphragms. Dismissing withdrawal as a legitimate contraceptive method is counterproductive for the prevention of pregnancy and also discourages academic inquiry into this frequently used and reasonably effective method.”

OK: And what’s the message from sex educators? They’d remain circumspect, they say (as the study does not suggest otherwise), about who does and doesn’t fit the withdrawal-method profile. Like, maybe not the kids. “Younger men have less awareness and control over ejaculation, and younger women are more fertile than older women,” Scarleteen founder Heather Corinna told Broadsheet. “And if we’re being really forthright, we also can safely say this is probably the most-sabotaged method by male partners. In other words, it’s the one male partners will most often agree to, then not comply with, either by talking a female partner into just letting them ejaculate, or by saying they did so on accident when it wasn’t at all accidental.” Safe to say we can agree on this: Withdrawal — whether method, mistake or manipulation — is, at very least, not a joke.