Coitus interruptus

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Coitus interruptus
Background
B.C. type	Natural
First use	> 2000 years ago
Failure rates (per year)
Perfect use	4%
Typical use	15-28%
Usage
Reversibility	Yes
User reminders	Dependent upon self-control of man. Urinating between acts of sexual intercourse helps clear sperm from urethra.
Clinic review	None
Advantages
Benefits	No side effects
Disadvantages
STD protection	No

Coitus interruptus, also known as withdrawal or the pull out method, is a method of contraception in which, during sexual intercourse, the penis is removed from the vagina prior to ejaculation, primarily to avoid introducing semen into 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]

Contents 1 Effectiveness 2 Advantages 3 Disadvantages 4 Prevalence 5 See also 6 References 7 Notes

[edit] 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.^[2] In comparison the pill has an actual use failure rate of 2-8%,^[3] while the diaphragm has an actual use failure rate of 10-39%.^[4][2] The condom has an actual use failure rate of 10-18%.^[2]

For couples that use withdrawal 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%, while the diaphragm has a perfect use failure rate of 6%. The condom has a perfect-use failure rate of 2%.^[5]

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.^[6] 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.^[7]

It has been suggested that the pre-ejaculate ("Cowper's fluid"), fluid emitted by the penis prior to ejaculation, contains spermatozoa (sperm cells), and is easily drawn into the vagina by capillary action. However, several small studies^[8][9] 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.^[10] 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 his penis).^[11]

[edit] 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 protect their partners from possible adverse effects of contraceptives.^[12]) It has no monetary cost, requires no artificial devices, has no physical side effects, and can be practiced without a prescription or medical consultation.

[edit] Disadvantages

Withdrawal is largely ineffective in the prevention of STDs, like HIV, since pre-ejaculate may carry viral particles or bacteria which may infect the partner if this fluid comes in contact with mucous membranes. However, a reduction in the volume of bodily fluids exchanged during intercourse may reduce the likelihood of disease transmission due to the smaller number of pathogens present.^[8]

The method may be difficult for some men to use. The interruption of intercourse may leave the affected parties dissatisfied, as some males have stated that the act is analogous to walking out of a theater just before the end of a climactic movie.^[13]

[edit] 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.)^[14]

In the United States, 56% of women of reproductive age have ever had a partner use withdrawal. In 2002, 2.5% were using withdrawal as their primary method of contraception.^[15]

[edit] See also

• coitus reservatus
• Natural birth control

[edit] References

• Rogow, Deborah, and Horowitz, Sonya. (1995). "Withdrawal: A Review of the Literature and an Agenda for Research." Studies in Family Planning. Vol 26, No 3 (May-June 1995), pp. 140-153.

[edit] Notes

1. ^ Population Action International (1991). "A Guide to Methods of Birth Control." Briefing Paper No. 25, Washington, D. C.
2. ^ ^{a b c} Kippley, John, Sheila Kippley (1996). The Art of Natural Family Planning, 4th addition, Cincinnati, OH: The Couple to Couple League, p.146. ISBN 0-926412-13-2., which cites:
   

   Guttmacher Institute (1992). "Choice of Contraceptives". The Medical Letter on Drugs and Therapeutics 34: 111-114.
   Hatcher, RA, Trussel J, Stewart F, et al (1994). Contraceptive Technology, Sixteenth Revised Edition, New York: Irvington Publishers. ISBN 0-8290-3171-5.

3. ^ 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. PMID 11343482.
   Guttmacher Institute. Contraceptive Use. Facts in Brief. Guttmacher Institute. Retrieved on 2005-05-10. - see table First-Year Contraceptive Failure Rates
4. ^ Bulut A, Ortayli N, Ringheim K, Cottingham J, Farley T, Peregoudov A, Joanis C, Palmore S, Brady M, Diaz J, Ojeda G, Ramos R (2001). "Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey.". Contraception 63 (5): 267-75. PMID 11448468.
5. ^ Hatcher, RA, Trussel J, Stewart F, et al (2000). Contraceptive Technology, 18th Edition, New York: Ardent Media. ISBN 0-9664902-6-6.
6. ^ Creatsas G (1993). "Sexuality: sexual activity and contraception during adolescence.". Curr Opin Obstet Gynecol 5 (6): 774-83. PMID 8286689.
7. ^ Amir H. Mehryar, A. Aghajanian, B. Delavar, H. Eini-Zinab, & Shahla Kazemipour (2005). "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.
8. ^ ^{a b} (October 1993) "Researchers find no sperm in pre-ejaculate fluid". Contraceptive Technology Update 14 (10): 154-156. PMID 12286905.
9. ^ 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. PMID 12762415.
10. ^ Withdrawal Method. Planned Parenthood (March 2004). Retrieved on 2006-09-01.
11. ^ Delvin, David (January 17, 2005). Coitus interruptus (Withdrawal method). NetDoctor.co.uk. Retrieved on 2006-07-13.
12. ^ Ortayli, N et al (2005). "Why Withdrawal? Why not withdrawal? Men's perspectives.". Reproductive Health Matters 25 (13): 164-73. PMID 16035610.
13. ^ Coitus Interruptus (Withdrawal). Abstinence & Natural Birth Control Methods. Sexually Transmitted Disease Resource (2006). Retrieved on 2006-09-05.
14. ^ (2002). "Family Planning Worldwide: 2002 Data Sheet" (PDF). Population Reference Bureau. Retrieved on 2006-09-14.
15. ^ William D. Mosher, Gladys M. Martinez, Anjani Chandra, Joyce C. Abma, and Stephanie J. Willson (2002). "Use of Contraception and Use of Family Planning Services in the United States: 1982–2002. Advance Data No. 350" (PDF). Center for Disease Control. Retrieved on 2006-09-14.