From the Guidelines
The withdrawal method is not a reliable method of contraception at any time and is not recommended as a primary method to avoid pregnancy, with a typical failure rate of 22% as reported in the most recent study 1.
Overview of the Withdrawal Method
The withdrawal method, also known as "pulling out," is a traditional family planning method in which the man completely removes his penis from the vagina and away from the external genitalia of the female partner before he ejaculates, as described in 1. This method might be appropriate for couples who are highly motivated and able to use this method effectively, but it is not recommended for women with conditions that make pregnancy an unacceptable risk due to its relatively higher typical-use failure rates.
Effectiveness of the Withdrawal Method
The effectiveness of the withdrawal method depends on the willingness and ability of the couple to use withdrawal with every act of intercourse, as stated in 1. However, even with perfect timing and execution, pre-ejaculate fluid released before orgasm may contain sperm that can cause pregnancy. The typical failure rate of withdrawal is about 22%, meaning that about 22 out of 100 women who use this method will become pregnant within a year, according to 1.
Comparison with Other Contraceptive Methods
In comparison to other contraceptive methods, the withdrawal method has a higher failure rate, as shown in the table from 1. More reliable methods such as hormonal contraceptives (pills, patches, rings), long-acting reversible contraceptives (IUDs, implants), and barrier methods (condoms) have much lower failure rates and provide more consistent protection against unintended pregnancy.
Recommendations
If you want to prevent pregnancy effectively, consider more reliable methods such as hormonal contraceptives, long-acting reversible contraceptives, or barrier methods, or speak with a healthcare provider about options that would work best for your situation, as suggested in 1. These methods have been shown to have lower failure rates and provide more consistent protection against unintended pregnancy. Additionally, emergency contraceptive pills or insertion of a copper intrauterine contraceptive after unprotected intercourse can substantially reduce the risk of pregnancy, as reported in 1.
From the Research
Withdrawal Method and Pregnancy Prevention
- The withdrawal method is less effective for preventing pregnancy than other contraceptive methods and offers no protection against sexually transmitted infections, including HIV 2.
- Among US adult women, 13% reported that withdrawal was the most effective method used in the last 30 days, but 33% had used withdrawal at least once 3.
- Younger women, women in dating relationships, and women strongly motivated to avoid pregnancy had some of the highest levels of "dual" use of withdrawal with condoms or highly effective methods 3.
Effectiveness of Contraceptive Methods
- Oral contraceptive pills are the most commonly used reversible method of contraception, with pregnancy rates of 4% to 7% per year 4.
- Long-acting methods, such as intrauterine devices and subdermal implants, have failure rates of less than 1% per year 4.
- The copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPA) are available emergency contraceptive options in the United States 5.
Best Time for Withdrawal Method
- There is no specific research on the best time for the withdrawal method to avoid pregnancy, as it is not considered a reliable method of contraception 3, 2, 4, 5.
- Health care providers should discuss the pros and cons of withdrawal with their clients and help ensure that they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections 3, 2.