Coitus interruptus

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Coitus interruptus
Background
B.C. type Behavioral
First use Ancient
Failure rates (first year)
Perfect use 4%
Typical use 15-28%
Usage
Reversibility Yes
User reminders Dependent upon self-control. Urinating between acts of sexual intercourse helps clear sperm from urethra.
Clinic review None
Advantages and disadvantages
STD protection No
Benefits No side effects
For criticism see Criticism of Coitus_interruptus

Coitus interruptus, also known as withdrawal or the pull-out method, is a method of contraception in which a couple has sexual intercourse, but semen is ejaculated outside of and away from the vagina. Coitus interruptus may also more generally refer to any extraction of the penis prior to ejaculation during intercourse. This method has been widely used for at least 2,000 years and was used by an estimated 38 million couples worldwide in 1991.[1] Some medical professionals view withdrawal as an ineffective method of birth control.[2]

Contents

History

Perhaps the oldest documentation of the use of the withdrawal method to avoid pregnancy is the story of Onan in the Hebrew Bible. This text is believed to have been written down over 2,500 years ago.[3] Societies in the ancient civilizations of Greece and Rome preferred small families and are known to have practiced a variety of birth control methods.[4]:12,16-17 There are references that have led historians to believe withdrawal was sometimes used as birth control.[5] However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries, and ineffective, such as amulets).[4]:17,23

After the decline of the Roman Empire in the 400s, contraceptive practices fell out of use in Europe; the use of contraceptive pessaries, for example, is not documented again until the fifteenth century. If withdrawal were used during the Roman Empire, knowledge of the practice may have been lost during its decline.[4]:33,42 A contributing factor to the loss of contraceptive knowledge was the rise of Christianity, which considered all forms of birth control to be sins.[4]:35,37

From the eighteenth century until the development of modern methods, withdrawal was one of the most popular methods of birth control in Europe, America, and elsewhere.[5]

Effectiveness

Like many methods of birth control, reliable effectiveness is achieved only by correct and consistent use. Observed failure rates of withdrawal vary depending on the population being studied: studies have found actual failure rates of 15-28% per year.[6] In comparison the pill has an actual use failure rate of 2-8%,[7] while the intrauterine device (IUD) has an actual use failure rate of 0.8%.[8] The condom has an actual use failure rate of 10-18%.[6] (see Comparison of birth control methods)

For couples that use coitus interruptus correctly at every act of intercourse, the failure rate is 4% per year. In comparison the pill has a perfect-use failure rate of 0.3%, and the IUD has a perfect-use failure rate of 0.6%. The condom has a perfect-use failure rate of 2%.[8]

The primary cause of failure of the withdrawal method is the lack of self-control of those using it. Poor timing of the withdrawal can result in semen on the vulva, which can easily migrate into the female reproductive tract. Some medical professionals view withdrawal as an ineffective method of birth control.[2] In contrast, a recent study in Iran found that provinces with higher rates of withdrawal use do not have higher fertility rates, and that the contribution of withdrawal use to unintended pregnancies is not markedly different from that of other commonly used methods such as the pill or condom.[9]

It has been suggested that the pre-ejaculate ("Cowper's fluid") emitted by the penis prior to ejaculation normally contains spermatozoa (sperm cells), which would compromise the effectiveness of the method.[10][11] However, several small studies[12][13] have failed to find any viable sperm in the fluid. While no large conclusive studies have been done, it is now believed the primary cause of method (correct-use) failure is the pre-ejaculate fluid picking up sperm from a previous ejaculation.[14] For this reason, it is recommended that users of withdrawal have the male partner urinate between ejaculations, to clear the urethra of sperm, and wash any ejaculate from objects that might come near the woman's vulva (e.g. hands and penis).[15]

Advantages

The advantage of coitus interruptus is that it can be used by people who have objections to or do not have access to other forms of contraception. (Some men prefer it so they can avoid possible adverse effects of hormonal contraceptives on their partners.[16]) Some women also prefer this method over hormonal contraception to avoid adverse effects such as depression, mood swings, vaginal dryness, decreased libido, and headaches, among others. It has no direct monetary cost, requires no artificial devices, has no physical side effects, can be practiced without a prescription or medical consultation, and provides no barriers to stimulation.

Prevalence

Worldwide, 3% of women of childbearing age rely on withdrawal as their primary method of contraception. Regional popularity of the method varies widely, from a low of 1% on the African continent to 16% in Western Asia. (Data from surveys during the late 1990s).[17]

In the United States, studies have indicated 56% of women of reproductive age have had a partner use withdrawal. In 2002, 2.5% were using withdrawal as their primary method of contraception.[18]

References

  1. ^ Rogow D, Horowitz S (1995). "Withdrawal: a review of the literature and an agenda for research". Studies in family planning 26 (3): 140–53. DOI:10.2307/2137833. PMID 7570764. , which cites:
    Population Action International (1991). "A Guide to Methods of Birth Control." Briefing Paper No. 25, Washington, D. C.
  2. ^ a b Creatsas G (1993). "Sexuality: sexual activity and contraception during adolescence". Curr Opin Obstet Gynecol 5 (6): 774–83. PMID 8286689. 
  3. ^ Adams, Cecil (2002-01-07). "Who wrote the Bible? (Part 1)". The Straight Dope. Creative Loafing Media, Inc.. http://www.straightdope.com/columns/read/1985/who-wrote-the-bible-part-1. Retrieved on 2009-07-24. 
  4. ^ a b c d Collier, Aine (2007). The Humble Little Condom: A History. Amherst, NY: Prometheus Books. ISBN 978-1-59102-556-6. 
  5. ^ a b Bullough, Vern L. (2001). Encyclopedia of birth control. Santa Barbara, Calif: ABC-CLIO, 74–75. ISBN 1-57607-181-2. Retrieved on 2009-07-24. 
  6. ^ a b Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning, 4th addition, Cincinnati, OH: The Couple to Couple League, 146. ISBN 0-926412-13-2. , which cites:
    Guttmacher Institute (1992). "Choice of Contraceptives". The Medical Letter on Drugs and Therapeutics 34: 111–114. DOI:<a 10.1016/j.<a. 
    Hatcher, RA; Trussel J, Stewart F, et al. (1994). Contraceptive Technology, Sixteenth Revised, New York: Irvington Publishers. ISBN 0-8290-3171-5. 
  7. ^ Audet MC, Moreau M, Koltun WD, Waldbaum AS, Shangold G, Fisher AC, Creasy GW (2001). "Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: a randomized controlled trial" (Slides of comparative efficacy]). JAMA 285 (18): 2347–54. DOI:10.1001/jama.285.18.2347. PMID 11343482. 
    Guttmacher Institute. "Contraceptive Use". Facts in Brief. Guttmacher Institute. http://www.agi-usa.org/pubs/fb_contr_use.html. Retrieved on 2005-05-10.  - see table First-Year Contraceptive Failure Rates
  8. ^ a b Hatcher, RA; Trussel J, Stewart F, et al. (2000). Contraceptive Technology, 18th, New York: Ardent Media. ISBN 0-9664902-6-6. 
  9. ^ Amir H. Mehryar, A. Aghajanian, B. Delavar, H. Eini-Zinab, & Shahla Kazemipour. "Continuing use of a traditional method (withdrawal) in a high contraceptive prevalence country, Iran: Correlates and consequences". Ministry of Science, Research and Technology, Iran. Retrieved on 2006-09-14.
  10. ^ Harms, Roger W. (2007-09-20). "Can pre-ejaculation fluid cause pregnancy?". Women's health: Expert answers. MayoClinic.com. http://www.mayoclinic.com/health/birth-control/an00197. Retrieved on 2009-07-15. 
  11. ^ Cornforth, Tracee (2003-12-02). "How effective is withdrawal as a birth control method?". About.com: Women's Health. http://womenshealth.about.com/cs/birthcontro1/a/withdrawalbircn.htm. Retrieved on 2009-07-15. 
  12. ^ Zukerman, Z.; Weiss D.B. Orvieto R. (April 2003). "Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm?". Journal of Assisted Reproduction and Genetics 20 (4): 157–159. DOI:10.1023/A:1022933320700. PMID 12762415. 
    Free M, Alexander N (1976). "Male contraception without prescription. A reevaluation of the condom and coitus interruptus" (PDF). Public Health Rep 91 (5): 437–45. PMID 824668. Retrieved on 2007-03-06. 
  13. ^ (October 1993) "Researchers find no sperm in pre-ejaculate fluid". Contraceptive Technology Update 14 (10): 154–156. DOI:<a 10.1016/j.<a. PMID 12286905. 
  14. ^ "Withdrawal Method". Planned Parenthood. March 2004. http://www.plannedparenthood.com/health-topics/birth-control/withdrawal-pull-out-method-4218.htm. Retrieved on 2008-03-28. 
  15. ^ Delvin, David (2005-01-17). "Coitus interruptus (Withdrawal method)". NetDoctor.co.uk. http://www.netdoctor.co.uk/sex_relationships/facts/coitusinterruptus.htm. Retrieved on 2006-07-13. 
  16. ^ Ortayli, N et al. (2005). "Why Withdrawal? Why not withdrawal? Men's perspectives". Reproductive Health Matters 25 (13): 164–73. DOI:10.1016/S0968-8080(05)25175-3. PMID 16035610. 
  17. ^ . "Family Planning Worldwide: 2002 Data Sheet" (PDF). Population Reference Bureau. Retrieved on 2006-09-14.
  18. ^ Chandra, A; Martinez GM, Mosher WD, Abma JC, Jones J. (2005). "Fertility, Family Planning, and Reproductive Health of U.S. Women: Data From the 2002 National Survey of Family Growth" (PDF). Vital Health Stat 23 (25). Retrieved on 2007-05-20.  See Tables 53 and 56.

Further reading

See also

v • d • e
Birth control methods (G02B)
Comparison
Behavioral
Avoiding vaginal intercourse: Anal sex · Oral sex · Non-penetrative sex · Masturbation · Abstinence
Including vaginal intercourse: Fertility awareness · Calendar-based methods (rhythm, etc.) · Withdrawal · Breastfeeding infertility (LAM)
Barrier or
spermicidal
Hormonal
Combined: Oral ('the Pill') · Contraceptive patch · Injectable · NuvaRing · extended cycle
Progestogen only: Oral ('minipill') · Depo-Provera · Implanon · Norplant/Jadelle
Anti-estrogen
Ormeloxifene (Centchroman)
Post-intercourse
Emergency contraception (pills or copper IUD)
Intrauterine
Intrauterine device (copper IUD) · Intrauterine system (progestogen, e.g., Mirena)
Abortion
Surgical · Medical (RU-486/abortion pill)
Sterilization
Female: Tubal ligation · Essure
Male: Vasectomy
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