How effective is withdrawal? How dangerous is pre-ejaculatory fluid? #605/15

Q:        Could the fluid that comes out before complete ejaculation make my girlfriend pregnant?  We had sex for a minute or two before I pulled out.

A:        The following paragraph from page 410 of the 20th edition of Contraceptive Technology provides a fairly complete answer to your question:

In itself, the pre-ejaculate, a lubricating secretion produced by the Littre or Cowper’s glands, presumably contains no sperm.  Although two studies examining the pre-ejaculate for the presence of spermatozoa found none, two other studies found spermatozoa, though in small numbers.  In one of these studies, 8 of 23 samples contained clumps of a new hundred sperm, which could theoretically have posed a risk of fertilization.  In a recond study designed specifically to determine whether pre-ejaculate of 37% of men contrained motile sperm, though the number of sperm in each sample was low.  Because of the number of sperm in each pre-ejaculate was low, the risk of pregnancy would be low, though not zero.  Each man in the study was consistent in either leaking or not leaking sperm in with the pre-ejaculate fluid.

As with other methods, withdrawal’s efficacy in preventing pregnancy probably may depend not only on characteristics of the method (whether the man’s pre-ejaculate contains sperm), but also on characteristics of the user.  Men who are less experienced with using the method or who have difficulty in foretelling when ejaculation will occur could have a greater risk of failure.  It may be that certain cultural factors influence how successful a couple may be in using withdrawal.  A recent study found that Hispanic women relying on withdrawal were less likely to experience accidental pregnancy than were black or white women.

For typical users, our best guess based on the 1995 and 2002 National Survey of Family Growth (NSFG) has been that the probability of pregnancy among typical users would be about 22% during the first year of use.  Among couples practicing withdrawal perfectly, the probability of pregnancy among perfect users might be about 4% in the initial year of use, (Table 3-1)  The immense difference between the 22% failure rate in typical users and the 4% rate if used perfectly attests to the difficulty couples have in using withdrawal consistently and correctly. 

As a method of contraception, withdrawal has several distinct advantages.  It costs nothing, requires no devices, involves no chemicals, and is available in any situation.  Some couples may select withdrawal as their method because it requires no plysical examination or contact with a clinic or pharmacy.  Practicing coitus interruptus causes no medical side-effects.

This question of sperm in the pre-ejaculate is one drawback of the coitus interruptus method of contraception.  But let me step back and define what is meant by withdrawal: 

Withdrawal really means “no deposit, no return!:  When the man senses that he is about to come, he pulls his penis out of the vagina.  He ejaculates (comes) outside of the vagina.  This takes a lot of discipline!  If the woman has not had an orgasm, the man can stimulate her in other ways after withdrawal.  It works best if the couple have discussed and agreed in advance to use this method.  Among typical couples who initiate use of withdrawal, about 22.1% will experience an accidental pregnancy in the first year.  If withdrawal is used consistently and correctly, about 4% will become pregnant (better than the diaphragm, cervical cap, sponge or vaginal spermicides!).

The biggest advantages of withdrawal are as follows:

  • Withdrawal is always an option.  Completely private.
  • You may be surprised at how effective it is.  It is definitely better than no method at all.
  • No fluid or much less fluid is deposited in the woman’s vagina.  This means that there is somewhat less chance of infection spreading from a man to the woman.
  • No medical complications or side-effects.  No hormones.  No chemicals and supplies are free

The three big disadvantages of this method are as follows:

  • If a man releases pre-ejaculate prior to orgasm, one-third of the time it will contain motile sperm.
  • Poor protection from spread of infection.
  • The big problem is that couples want to keep thrusting when it is time for him to pull out. 

This gets the man thinking:

  • Will I withdraw in time or this is too much fun.  I don’t want to withdraw from the vagina just yet.
  • Will he withdraw in time?  Or thinking “I don’t want him to come out of my vagina yet.”
  • These concerns decrease a couple’s enjoyment of intercourse.

Robert A. Hatcher MD, MPH

Emeritus Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA

July 2, 2015, Updated 7-13-2015 

Key Words:  dangerous, pre-ejaculate fluid, pregnant, sex, withdrawal, Contraceptive Technology, coitus, penis, vagina, discipline, method, accidental, diaphragm, cervical cap, sponge, vaginal spermicides, infection, hormones, advantages, disadvantages, intercourse, effectiveness, National Survey of Family Growth, spermatozoa, fertilizing, egg, chemicals, devices

To learn more about the advantages and disadvantages of withdrawal, go to: www.managingcontraception.com.   You can order all of these books listed below from our website or by calling 404-875-5001.       

Reference:

Kowal D, Coitus interruptus (Withdrawal) IN Hatcher RA, Trussell J, Nelson AL, Cates Jr. W, Kowal D, Policar MS, et al Contraceptive Technology 20th edition; pages 410 & 411: Ardent Media Inc. 2011

Current Books:

Contraceptive Technology 20th edition

Managing Contraception 2015-2016 edition

Choices 2014 edition

The authors advise consultation of a primary-care provider or a specialist before making decisions about, managing, or treating any problem discussed in these questions and answers.  Under no circumstances should the information provided on this website be used instead of, or to override the judgment of the treating provider.

choices_2013_Eng mc2013

 

 

Skills

Posted on

July 9, 2015