Coitus interruptus
Encyclopedia
Coitus interruptus, also known as the rejected sexual intercourse
, withdrawal or pull-out method, is a method of birth-control in which a man, during intercourse withdraws his penis from a woman's vagina prior to ejaculation
. The man then directs his ejaculate (semen
) away from his partner's vagina
in an effort to avoid insemination
.
This method of contraception
, widely used for at least two millennia, is still in use today. This method was used by an estimated thirty-eight million couples worldwide in 1991. Coitus interruptus does not protect against STDs or STIs and is viewed by medical professionals to be an ineffective method of birth control.
in the Torah
. This text is believed to have been written down over 2,500 years ago. Societies in the ancient civilizations of Greece
and Rome
preferred small families and are known to have practiced a variety of birth control methods. There are references that have led historians to believe withdrawal was sometimes used as birth control. However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries
, and ineffective, such as amulet
s).
After the decline of the Roman Empire
in the 5th century, contraceptive practices fell out of use in Europe; the use of contraceptive pessaries, for example, is not documented again until the 15th century. If withdrawal were used during the Roman Empire, knowledge of the practice may have been lost during its decline.
From the 18th century until the development of modern methods, withdrawal was one of the most popular methods of birth-control in Europe, North America, and elsewhere.
(IUD) has an actual use failure rate of 0.8%. The condom
has an actual use failure rate of 10–18%. However some authors suggest that actual effectiveness of withdrawal could be similar to effectiveness of condoms, and this area needs further research. (see Comparison of birth control methods
)
For couples that use coitus interruptus 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%, and the I.U.D. has a perfect-use failure rate of 0.6%. The condom has a perfect-use failure rate of 2%.
It has been suggested that the pre-ejaculate
("Cowper's fluid") emitted by the penis prior to ejaculation normally contains spermatozoa
(sperm cells), which would compromise the effectiveness of the method. However, several small studies 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. For this reason, it is recommended that 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 penis).
The method 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 compared to using no method due to the smaller number of pathogens present.
The method may be difficult for some couples to use. The interruption of intercourse may leave some couples sexually frustrated or dissatisfied.
Masters and Johnson
considered withdrawal as a means to developing sexual problems
, e.g. premature ejaculation
and erectile dysfunction
.
In the United States, studies have indicated 56% of women of reproductive age have had a partner use withdrawal. By 2002, only 2.5% were using withdrawal as their primary method of contraception.
A leading exponent of withdrawal in the mid-nineteenth century was a religious based "utopian commune" called the Oneida community
in New York. To minimize the incidence of pregnancy, teenage males were not permitted to engage in sexual intercourse
except with postmenopausal women until such time as they mastered the withdrawal technique.
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, withdrawal or pull-out method, is a method of birth-control in which a man, during intercourse withdraws his penis from a woman's vagina prior to ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
. The man then directs his ejaculate (semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
) away from his partner's vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
in an effort to avoid insemination
Insemination
Insemination is the deliberate introduction of sperm into the uterus of a mammal or the oviduct of an oviparous animal for the objective of impregnating a female for reproduction...
.
This method of contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...
, widely used for at least two millennia, is still in use today. This method was used by an estimated thirty-eight million couples worldwide in 1991. Coitus interruptus does not protect against STDs or STIs and is viewed by medical professionals to be an ineffective method of birth control.
History
Perhaps the oldest documentation of the use of the withdrawal method to avoid pregnancy is the story of OnanOnan
Onan is a minor biblical person in the Book of Genesis , who was the second son of Judah. Just like his older brother, Er, Onan died prematurely by YHWH's will for being wicked....
in the Torah
Torah
Torah- A scroll containing the first five books of the BibleThe Torah , is name given by Jews to the first five books of the bible—Genesis , Exodus , Leviticus , Numbers and Deuteronomy Torah- A scroll containing the first five books of the BibleThe Torah , is name given by Jews to the first five...
. This text is believed to have been written down over 2,500 years ago. Societies in the ancient civilizations of Greece
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...
and Rome
Roman Empire
The Roman Empire was the post-Republican period of the ancient Roman civilization, characterised by an autocratic form of government and large territorial holdings in Europe and around the Mediterranean....
preferred small families and are known to have practiced a variety of birth control methods. There are references that have led historians to believe withdrawal was sometimes used as birth control. However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries
Pessary
A pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
, and ineffective, such as amulet
Amulet
An amulet, similar to a talisman , is any object intended to bring good luck or protection to its owner.Potential amulets include gems, especially engraved gems, statues, coins, drawings, pendants, rings, plants and animals; even words said in certain occasions—for example: vade retro satana—, to...
s).
After the decline of the Roman Empire
Decline of the Roman Empire
The decline of the Roman Empire refers to the gradual societal collapse of the Western Roman Empire. Many theories of causality prevail, but most concern the disintegration of political, economic, military, and other social institutions, in tandem with foreign invasions and usurpers from within the...
in the 5th century, contraceptive practices fell out of use in Europe; the use of contraceptive pessaries, for example, is not documented again until the 15th century. If withdrawal were used during the Roman Empire, knowledge of the practice may have been lost during its decline.
From the 18th century until the development of modern methods, withdrawal was one of the most popular methods of birth-control in Europe, North America, and elsewhere.
Effect
Like many methods of birth control, reliable effect 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. In comparison, the pill has an actual use failure rate of 2–8%, while the intrauterine deviceIntrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
(IUD) has an actual use failure rate of 0.8%. The condom
Condom
A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...
has an actual use failure rate of 10–18%. However some authors suggest that actual effectiveness of withdrawal could be similar to effectiveness of condoms, and this area needs further research. (see Comparison of birth control methods
Comparison of birth control methods
Different types of birth control methods have large differences in effectiveness, actions required of users, and side effects.-Ease of use:Different methods require different actions of users. Barrier methods, spermicides, and coitus interruptus must be used at every act of intercourse. The male...
)
For couples that use coitus interruptus 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%, and the I.U.D. has a perfect-use failure rate of 0.6%. The condom has a perfect-use failure rate of 2%.
It has been suggested that the pre-ejaculate
Pre-ejaculate
Pre-ejaculate is the clear, colorless, viscous fluid that emits from the urethra of a man's penis when he is sexually aroused. It is similar in composition to semen, but has some significant chemical differences...
("Cowper's fluid") emitted by the penis prior to ejaculation normally contains spermatozoa
Spermatozoon
A spermatozoon is a motile sperm cell, or moving form of the haploid cell that is the male gamete. A spermatozoon joins an ovum to form a zygote...
(sperm cells), which would compromise the effectiveness of the method. However, several small studies 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. For this reason, it is recommended that 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 penis).
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 avoid possible adverse effects of hormonal contraceptives on their partners. Some women also prefer this method over hormonal contraception to avoid adverse effects such as depression, mood swings, vaginal dryness, decreased libido, weight gain, and headaches, among others. It has no direct monetary cost, requires no artificial devices, has no physical side effects, can be practiced without a prescription or medical consultation, and provides no barriers to stimulation.Disadvantages
Compared to the other common reversible methods of contraception such as IUDs, hormonal contraceptives and male condoms, coitus interruptus is less effective at preventing pregnancy. As a result, it is also less cost-effective than many more effective methods: although the method itself has no direct cost, users have a greater chance of incurring the risks and expenses of either pregnancy and child-birth or abortion. Only models that assume all couples practice perfect use of the method find cost savings associated with the choice of withdrawal as a birth control method.The method is largely ineffective in the prevention of STDs, like HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, since pre-ejaculate
Pre-ejaculate
Pre-ejaculate is the clear, colorless, viscous fluid that emits from the urethra of a man's penis when he is sexually aroused. It is similar in composition to semen, but has some significant chemical differences...
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 compared to using no method due to the smaller number of pathogens present.
The method may be difficult for some couples to use. The interruption of intercourse may leave some couples sexually frustrated or dissatisfied.
Masters and Johnson
Masters and Johnson
The Masters and Johnson research team, composed of William H. Masters and Virginia E. Johnson, pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual disorders and dysfunctions from 1957 until the 1990s....
considered withdrawal as a means to developing sexual problems
Sexual dysfunction
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....
, e.g. premature ejaculation
Premature ejaculation
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....
and erectile dysfunction
Erectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
.
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).In the United States, studies have indicated 56% of women of reproductive age have had a partner use withdrawal. By 2002, only 2.5% were using withdrawal as their primary method of contraception.
A leading exponent of withdrawal in the mid-nineteenth century was a religious based "utopian commune" called the Oneida community
Oneida Community
The Oneida Community was a religious commune founded by John Humphrey Noyes in 1848 in Oneida, New York. The community believed that Jesus had already returned in the year 70 AD, making it possible for them to bring about Jesus's millennial kingdom themselves, and be free of sin and perfect in this...
in New York. To minimize the incidence of pregnancy, teenage males were not permitted to engage in sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
except with postmenopausal women until such time as they mastered the withdrawal technique.