Why the withdrawal method has made a comeback


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Growing up in Adelaide, Nicole* was a stickler when it came to contraception. She didn’t want to get pregnant and she didn’t want an STI, so she always used condoms or the pill. Often both. But when she broke up with her high school sweetheart, at age 20, she stopped taking the pill, figuring that if she wasn’t having regular sex, it wasn’t worth the bother. “I noticed a lot of positive changes in my body, my energy levels, my sex drive and subsequently my personality,” she recalls. So she decided to continue not taking it.

When Nicole met her next boyfriend, she told him why she didn’t want to use the pill, and he was supportive. For the first few months, they used condoms. But as attraction transformed into love, they switched to a rather more old fashioned method: he would “pull out” before he came. Sex without condoms was more pleasurable for both of them, they reasoned, and they had been tested for STIs. They both knew that sex with a condom would be safer, but he never came inside of her, and she never got pregnant.

Now in a new relationship for over a year, Nicole, now 23, employs another method of pregnancy prevention, a hybrid of “pull out” and prophylactic: she and her boyfriend will have sex at first without a condom, before putting on one a few minutes before he is ready to come.

Chances are this isn’t the kind of “contraception” you covered in sex education at school, but it’s more common than you might think. A Duke University study of 2,220 American women aged between 15 and 24 found that 31 percent had used withdrawal as a form of birth control at least once over a four year period. And those numbers may be an artificial low. Rachel K Jones, a medical researcher at the Guttmacher Institute in New York, notes that withdrawal rates are often underestimated, as patients are unlikely to disclose use of the method unless they are directly asked. And survey administrators often give priority to the most effective method used, meaning that women like Nicole, who use withdrawal in tandem with condoms or the pill, often go unspoken about.

Responding to the studyNew York Magazine journalist Ann Friedman dubbed it “the Pullout Generation,” citing twenty- and thirty-something inner-urbanites who “bought organic kale and all-natural cleaning products, and so can’t quite get down with taking synthetic hormones every day.” Jezebel wondered if it might be a reflection of what writer Tracy Moore termed “pregnancy ambivalence” – that is to say, that perhaps couples using the “pull out” method weren’t so opposed to the idea of getting pregnant after all. They just weren’t ready to start actively “trying” for a baby.

But the real question behind the return of the withdrawal method isn’t, “Why aren’t women taking the pill?” It’s why, after decades of education on safer sex and STIs, so many people are still reluctant to use condoms.

There are good reasons a woman might not want to use the pill – reasons that have nothing to do with shopping organic or secretly hankering for a baby.  “I already have depression,” says Christina, a bespectacled 20-year-old from Auckland. “I don’t want to take something that lists depression as a potential side effect. Rosemary, 36 and from Sydney, stopped taking hormonal contraceptives after she suffered a stroke in her late twenties. I too haven’t touched the pill in six years, after a month of incapacitating migraines (starting just a week after I’d commenced taking it again) had my GP instruct me to stop taking it pronto.

The condom question too has a multitude of answers. For a lot of people, sex just doesn’t feel as good with a condom as it does without one. Condoms work well for straight forward penetrative sex, but they can be a trickier proposition in more “creative” encounters. “My partner and I tend to have sex for a fairly long time and alternate between different activities a lot,” Christina explains. “Condoms are a nightmare if the person wearing them is going between hard and various degrees of flaccid for several hours while doing a bajillion different things.”

And despite two decades of “no glove, no love” campaigns, using a condom is still associated with a lack of trust, meaning they tend to get thrown out the metaphorical window in steady relationships – whether the people involved have been tested for STIs or not. Indeed, the pill’s popularity may be partly responsible for the prevalence of the “pullout.” If sexually active women are presumed to be on the pill, what need is there to use a condom?

Which brings us to a point in the “pullout” debate that has been swept oddly under the carpet. Women may not all love using condoms, but in most heterosexual relationships, it is the male partner who drives the decision to stop using them. “Many men expect women to be on the pill and decide not to use condoms, without asking, which I find unacceptable,” says Nicole, recalling times when she had “verbal arguments during sex” because a one night stand didn’t want to use a condom. Amy, 26, tells me of the trouble she has had convincing her forty-something boyfriend to use one, even researching the most pleasurable varieties online. He still complained. “I love him and love being with him, so I agreed to [have sex without one],” she concedes.

Even in relationships in which the decision to use the withdrawal method is mutual, it is often a decision made based on the man’s pleasure, not the woman’s. “In terms of sensation, it didn’t make much difference to me whether he was wearing a condom or not,” says Melissa, 26, who used the withdrawal method with her ex-boyfriend. “My own physical pleasure didn’t factor into my thought process.”

So why has so much of the chatter around withdrawal focused on supposedly stupid decisions made by women?

It’s easy to shake your head at people who use the withdrawal method, but the truth is that lots of people do stupid things when it comes to sex – regardless of age, gender, or sexuality. A 2010 study found that more than 90 percent of men over 50 didn’t use a condom when they last had sex with a date or casual acquaintance. Nor is it just a post-HIV mirage of invincibility: condom use is higher now – amongst young people, at least – than it was in the early 1990s.

And withdrawal might not be as terrible an option as the internet handwringing would have you think. When it comes to preventing pregnancy, it is only slightly less effective than the male condom: with a failure rate of 4 percent if used effectively (that is, before the man ejaculates) and 18 percent based on typical use. It does nothing to protect against STIs, but neither does the oral contraceptive pill. And plenty of people take that risk every day. (They shouldn’t. Anecdote may not be data, but I know at least one twenty-something woman who has HIV.)

The truth is that when it comes to sex, humans are deeply fallible. We prioritise the pleasure of the present moment over potential future pain. We presume that if we love someone they cannot carry a harmful virus, as if viruses discriminate based on virtue or lovability. We hope and assume that whatever the worst might be, it won’t happen to us.

As such, effective sexual health campaigns need to not just teach us about the risks and how to avoid them, but to combat our fallibility, to ensure that even if we don’t always make the best choices, we at least make the least worst ones.

For Dr Annie Dude, author of the Duke study, that means talking to young people about contraception options other than condoms or the pill – she is a particular fan of the IUD and the rod. For Rachel Jones of the Guttmacher institute, it means doctors initiating conversations about withdrawal with their patients in a non-judgemental way; making them aware of the risks and “talking about the pros and cons.”

But perhaps the best idea to date has come from Bill Gates, whose Bill and Melinda Gates Foundation pledged in March to give a $100,000 grant to anyone who can develop a credible idea for a condom that “is felt to enhance pleasure,” rather than detract from it. If you can’t change the people, change the technology.

*Name has been changed