The pull out method is the form of birth control that your sex ed teachers probably warned you about. To do it, partners keep every last drop of ejaculation outside of the vagina and vulva every single time they have sex, in order to prevent pregnancy. Unlike other birth control methods, pulling out is somewhat difficult —it's definitely not foolproof at preventing pregnancy and doesn't protect against sexually transmitted infections (STIs). For these reasons, the pull out or withdrawal method has a bad reputation.
So, why do people do it? "For a lot of people, pulling out can be very convenient," says Nicole Cushman, MPH, sex educator and executive director of Answer, a sexuality education resource at Rutgers University. "It's not something that they have to think about, or prepare for in advance — it’s just always available." There's no cost or side effects (besides pregnancy) associated with pulling out, and you don't have to go to a doctor or clinic, she says. And finally, there are still pervasive opinions about condoms reducing sensation that sway people. "A lot of people think that pulling out is preferable because it feels better or more natural somehow," she says.
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In terms of effectiveness, the withdrawal method is considered 78% effective, meaning, about 22 out of 100 people who use this technique will get pregnant every year, according to Planned Parenthood. "That's not awful, but it's not very good either," Cushman says. (For comparison, combination oral contraceptives have a failure rate of 7%, and hormonal intrauterine devices have a 0.1-0.4% failure rate, according to the Centers for Disease Control.)
For a while, there was a lot of fear-mongering and exaggeration around the pull out method, Cushman says. "We hear things from teens who had so internalized that message that pulling out was ineffective, that they would think that it wasn’t worth doing at all," she says. Given the belief that the pull out method doesn't work, some people just have unprotected sex without any form of birth control. But the reality is that the pull out method is far more effective than doing nothing, she says.
To be very clear: "There is still a significant risk of pregnancy" when it comes to pulling out, Cushman says. For people who aren't familiar with their bodies, or sexually experienced, it may be difficult to read the signs that they're going to ejaculate, she says. And, obviously, pulling out doesn't guard you from sexually transmitted infections that are spread through sexual fluids.
If you're intrigued by the pull out method, or are already doing it, there are a few things you can do to ensure you're being as safe as possible. "Most important is that you and your partners need to be really aware of the potential risk and make sure that you're all comfortable with that," Cushman says. Assuming you're having sex without a condom, it's also crucial to get tested for STIs, and have your partners do the same, she says. Then, through masturbation, you can practice on your own so you can "predict ejaculation better" during sex, she says.
Ultimately, as with other birth control methods, it's worth it to think about it, assess your options, and make a decision accordingly. "This is really about weighing the pros and cons and figuring out what level of risk you're willing to accept," Cushman says. While pulling out might seem like the easiest way out of getting pregnant, you might have more piece of mind with a method that's proven more effective.