How effective is the pull-out method?

2nd December, 2022 • 9 min read

Also known as the withdrawal method, coitus interruptus (you’ll find that one in medical dictionaries) and ‘pull and pray’, the pull-out method is sometimes used as a type of birth control (contraception).

It’s when a person removes their penis from a vagina before they ‘cum’ (ejaculate). The idea is that this stops semen getting into the vagina, to prevent pregnancy.

But how effective is the pull-out method? And what are the pros, cons, and tips for using it? We’ve got them all for you…

Pull-out method effectiveness: the facts and figures

The pull-out method is one of the least effective types of contraception.

Here’s what you need to know:

  • it’s better than using no birth control, but you can still get pregnant if you use it
  • it’s about 78% effective at preventing pregnancy – meaning if 100 couples use this method for a year, 22 of them will get pregnant
  • some health services don’t consider it a form of contraception
  • it doesn’t protect you from
    sexually transmitted infections (STIs)

“The pull-out method can seem like a simple, natural and hassle-free way to practice birth control – one that you can use easily if you’re not prepared with contraception, don’t want to spoil the moment with

condoms
, have any worries about using hormonal birth control, or if it’s the method your partner prefers,” says Dr Ann Nainan, family doctor and Healthily expert.

“But if it’s important that you don’t get pregnant, or you want to protect yourself against STIs, it’s not a type of contraception that healthcare professionals recommend. Using more reliable contraception can put your mind at rest and free you up to enjoy your sex life.”

Who is most likely to use the pull-out method?

It may not work very well, but that doesn’t stop withdrawal being a popular choice of birth control – even though there are lots of other options (read about

other types of birth control and how effective they are
).

In fact, some research suggests pull-out method popularity is growing:

  • data from the National Center for Health Statistics found that between 2011 and 2015, 18.8% of men used it as their main form of contraception – most often men in their teens (26.2%) or aged 20 to 24 (21.2%) – which is an increase on previous figures
  • other research has found that 59% of American women have used the withdrawal method at some point
  • in the US, about 4.6% use withdrawal as their main method of contraception
  • in the UK, about 5% of women are thought to rely on it to avoid pregnancy

Why do people use the withdrawal method?

It may seem surprising that people use the pull-out method for contraception. But research shows there can be lots of reasons for choosing it.

It’s free, easy and always available

You don’t need to buy anything, go to the doctor, be organized or have any worries about side effects. And you can always use the pull-out method, which can make it a convenient option when you want to be spontaneous.

If it’s a question of withdrawal or no birth control, a couple may think that at least pulling out is better than nothing.

But remember – it isn’t really an effective method of birth control. So if you don’t want a pregnancy in your near future, it’s worth looking into other ways of avoiding it.

For extra protection

Although some people do seem to rely on it, lots of people use withdrawal alongside other methods. One study found at least half of those who use withdrawal pair it with other forms of birth control.

So, rather than being an irresponsible approach to contraception, researchers think that for some people, it could be a way of feeling more reassured they won’t get pregnant.

Studies suggest younger women, women dating casually, and those who feel very strongly that it’s important they don’t get pregnant are most likely to use the pull-out method, alongside more effective forms of contraception. In other words, they might double-up when they want to be really sure of avoiding pregnancy.

Men may like to use withdrawal for reassurance because it’s a method of contraception they have control over – perhaps when they don’t know whether a female partner is using hormonal contraception, or because they want to play their part in contraceptive responsibilities.

As an alternative to condoms

Research has found that condoms are more likely than other forms of contraception to be used in rotation with withdrawal, rather than in combination. So, it could be that couples save condom use for the most fertile times of the month, and use pulling out when they think the risk of pregnancy is lower.

Switching between these 2 methods could be down to couples compromising over condoms – using them only when they think they have to. In one study, people who felt that condoms affect pleasure reported sometimes using the withdrawal method.

As a feminist choice

This may sound strange, given that effective birth control was a key part of the feminist revolution – but some anecdotal evidence suggests some women may be rejecting taking responsibility for contraception.

They may not want to risk side effects from hormonal contraception, and the pull-out method may be seen as a natural choice that makes men take responsibility.

When pregnancy isn’t unwelcome

One study found women who said they’d be pleased about a pregnancy were more likely to use the pull-out method.

If you’re pretty relaxed about conceiving – or you want to get pregnant, but don’t like the idea of actively trying – you may feel okay about using a less reliable type of contraception.

To try to avoid STIs

According to research, some couples who use long-acting reversible contraceptives (LARCs) also use withdrawal.

Although it’s not clear why, one theory is that these couples may think that pulling out reduces the risk of STIs.

It’s worth repeating this: the pull-out method doesn’t protect against STIs.

What’s the problem with the withdrawal method?

If you do it perfectly, being very careful to keep cum (semen) away from the vagina and vulva, pulling out can work well. For every 100 couples who do it exactly right, about 4 will get pregnant.

But there are several problems, including:

  • it’s difficult to do it perfectly – especially if he’s been drinking alcohol, gets carried away, or finds it hard to predict when he’s going to cum. So, in real life, for every 100 couples who use it, about 22 will get pregnant
  • you both have to be committed to doing it perfectly – which means you need to really trust your partner. You need to know he’s as committed as you to avoiding pregnancy, and has the self-control to pull out before he cums
  • it’s thought that pre-cum (pre-ejaculate) may also contain sperm, meaning that sperm could be released before he pulls out – some research has found sperm in pre-cum, although one study found this was only the case for some men
  • it has been proven that STIs can be found in pre-cum, including
    HIV
    ,
    syphilis
    and
    chlamydia
    – and the pull-out method doesn’t protect you from STIs that are spread through skin-to-skin contact. Only condoms (male and
    female
    ) can help prevent the spread of STIs

The takeaway? If you want to be sure you’re taking the best steps to prevent pregnancy and STIs, using the pull-out method alone isn’t a good choice.

What you need to know if you do decide to use it

If you’ve weighed up your options and think withdrawal is right for you, there are a few things to consider, including:

  • making sure both you and your partner have tested negative for STIs – and using a condom until you have
  • understanding your pregnancy risk – this may be very low if you’re using the pull-out method with another type of contraception, but much higher if you’re using it on its own, so make sure you’re happy with your level of risk
  • keeping
    emergency contraception
    (such as the morning-after pill) to hand or knowing where to get some, if you’re hoping to avoid pregnancy
    – accidents can happen

When to see a doctor

If you want a more reliable contraceptive

The bottom line is that the pull-out method isn’t very effective at preventing pregnancy and doesn’t protect against STIs. But there are other types of contraception that are much more reliable.

“Your doctor or healthcare professional at a sexual health clinic or Planned Parenthood center can give you the lowdown on other forms of contraception, and help you work out which one may be right for you,” says Dr Ann.

“Don’t be put off by thinking they’ll tell you to use a contraceptive you’re not comfortable with – whether that’s hormonal contraception or condoms. There are so many options now, and ultimately, the choice is yours – you can go home and think about it, so there’s no rush. If you’re in a relationship, take your partner with you, so that they’re part of the decision.”

If you’re concerned about STIs

If you’ve been using the withdrawal method and you’re worried you’ve been exposed to STIs, visit a sexual health clinic as soon as possible.

They can run tests, and help you get any treatment you need. You can also pick up some condoms, to lower your risk in the future.

If you’re at risk of pregnancy (and that’s not okay)

You can use emergency contraception within 5 days of having unprotected sex. So don’t hesitate to go to your doctor, pharmacist or a

Planned Parenthood
center if pregnancy is an issue for you.

If it’s a longer time since you had sex and you’re worried, there are places you can get help – try Planned Parenthood in the US, or

Brook
in the UK.

Your health questions answered

How do I use the pull-out method with natural family planning?

Natural family planning
is a way of charting your most fertile time in each cycle,” explains Dr Ann.

“There are different methods, including checking your cervical mucus or using apps and you'll usually need to do daily readings. The idea is that you don’t use any contraception during most of the month, when you aren’t fertile. On fertile days, you either avoid sex or use contraception – and some people like to use the withdrawal method at this time."

"While pairing these 2 methods can reduce your risk of pregnancy, you need to be very good at both to make them effective. Doing this may be a great choice if you’re fairly relaxed about getting pregnant, follow the steps for natural family planning, and you’ve both tested negative for STIs. Otherwise, I’d advise finding a more reliable form of birth control – it can really ease your concerns.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.