Premature ejaculation: Withdrawal is not an effective method of birth control

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Premature ejaculation. In this case it refers to making claims about the effectiveness of withdrawal before there is any proof.

No doubt every gynecologist is cringing. We have spent years counseling patients that withdrawal is an ineffective method of preventing pregnancy, only somewhat better than nothing. Now researchers from the Guttmacher Institute have published a study that claims that to show that withdrawal is as effective as condoms, but actually shows nothing of the kind.

According to the paper Better than nothing or savvy risk-reduction practice? The importance of withdrawal (Contraception 79 (2009) 407–410):

Withdrawal is sometimes referred to as the contraceptive method that is “better than nothing”. But, based on the evidence, it might more aptly be referred to as a method that is almost as effective as the male condom—at least when it comes to pregnancy prevention. If the male partner withdraws before ejaculation every time a couple has vaginal intercourse, about 4% of couples will become pregnant over the course of a year. However, more realistic estimates of typical use indicate that about 18% of couples will become pregnant in a year using withdrawal. These rates are only slightly less effective than male condoms, which have perfect- and typical-use failure rates of 2% and 17%1, respectively.

In other words, when used improperly, both withdrawal and condoms are not very effective. When you consider what that means, it is only to be expected, and hardly an endorsement of the effectiveness of withdrawal.

The reason there is a vast gulf between typical use and perfect use in the case of both condoms and withdrawal is that in both cases “typical use” means that the method is not used all the time. It’s supposed to be used all the time, but in practice, condom users forget to put it on or put it on too late. For a significant portion of the time, real world condom users have sex without any protection against pregnancy.

Real world withdrawal users are often unprotected too. That’s because many men and boys who use withdrawal don’t have the self-control to withdraw in time. They intended to do so, but they couldn’t do so. For a significant portion of time, real world withdrawal users have sex without any protection against pregnancy.
It is hardly surprisingly that the study found couples who claim to be using condoms but are using nothing intermittently have the same pregnancy rate as couples who claim to be using withdrawal but are using nothing intermittently. That was only to be expected.

The real question is not what happens when you don’t use the method properly, but what happens when you do use the method properly. When used perfectly (in other words, every time) withdrawal (4% pregnancy rate) has double the pregnancy rate of condoms (2% pregnancy rate). It may sound like a trivial difference, but for couples who faithfully use either method (instead of intermittently using nothing), it makes a big difference because condoms are inherently more effective in preventing pregnancy … twice as effective.

The take home message is not that withdrawal is as effective as condom use. The study merely showed that regardless of method, if you don’t use it consistently, it will have an extraordinarily high pregnancy rate. That’s not news and it’s not helpful information for people trying to determine the safest method of contraception.

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