Fertilization and its discontents

It assumes many names: “the withdrawal method,” “the pull-out method,” “the exit strategy,” “the backup plan,” “the better-than-nothing plan,” and, less colloquially, “coitus interruptus.” But it assumes only one form: the withdrawal of a man’s unsheathed penis from a woman’s unprotected vagina immediately before he ejaculates in order to circumvent pregnancy.

According to Gwyn Ashcom, a health educator at Portland State’s Student Health and Counseling (SHAC), although the withdraw method technically qualifies as a family planning strategy, it tends to be practiced more than she recommends.

The American College Health Association’s 2008 survey lists withdrawal as the third most common method of birth control among college students (24.5 percent), falling behind birth control pills (62.6 percent) and male

condoms (69.4 percent).

Nevertheless, the effectiveness of withdrawal as a method of birth control is a recurring point of controversy in the medical community.

Planned Parenthood endorses the withdraw method as a means of birth control. According to the organization’s website, if practiced correctly, the withdraw method is “safe, easy, and convenient,” and boasts a 96 percent effectiveness rate.

To counteract risk, Planned Parenthood recommends that the man urinate before intercourse to clear any residual sperm from his urethra and to thoroughly wash any contaminated areas.

Apart from the dangers posed by pre- and post-ejaculate, there is the issue of whether the man is actually capable of withdrawing in time to reduce the risk of pregnancy.

 “If done correctly, a guy would have to have a lot of self-control to know exactly when he’s going to ejaculate, and to pull completely out,” Ashcom said.

And once he pulls out, he must not ejaculate anywhere near the woman’s vulva, for any sperm that lands on or near the woman’s mucus membranes might just make the migration necessary to impregnate her.

“It doesn’t really take a lot [of sperm],” she said. “And I think some people don’t realize that if they even have a little bit of ejaculation that that can potentially cause a pregnancy.”?

Planned Parenthood claims that, if practiced incorrectly, the effectiveness rate of the withdraw method drops considerably, down to approximately 78 percent.

On top of the risk of pregnancy, the withdraw method does not protect against sexually transmitted infections (STIs), for the obvious reason that is still entails an exchange of bodily fluids.

People who have sex with multiple partners and use the withdrawal tend to be disaster-prone, according to Ashcom.

Provided that a couple goes through all the right motions—a clean pre-ejaculate, a timely withdrawal, a vagina free of semen—there remains the inescapable emotional fallout of the withdraw method.

For this reason, Ashcom does not herself advocate withdrawal unless it is bolstered by other tried-and-true birth control methods, including the usual candidates: condoms, birth control pills, and the rhythm method.

“Education never hurts,” she said. “Getting as much information as you can about whatever is available to you, so you can make an informed decision, is the most important thing.”?