Coitus interruptus

The coitus interruptus or coitus interruptus, also known as withdrawal or withdrawal b>, is a method of contraception in which a couple has sexual intercourse, but the penis is withdrawn prematurely and the semen is ejaculated outside the vagina, or is not ejaculated and is retained inside the body.

Use of this method has been documented for at least 2,000 years, and was used by an estimated 38 million couples worldwide in 1991. This method does not prevent sexually transmitted infections.

Efficacy

According to studies, the rates of unwanted pregnancy observed in couples who used withdrawal as a contraceptive method were, depending on the population studied, between 15 and 28%. In comparison, in couples who used the contraceptive pill as a contraceptive method, including misuse, a failure rate of between 2 and 8% was observed, while with the intrauterine device (IUD) a failure rate of 0.8% was observed. According to Kippley in couples using condoms, including condom misuse, had a 10-18% failure rate.

According to some studies, in couples who use withdrawal correctly in each sexual act, it is estimated that the failure rate could be 4%. By comparison, oral contraceptives are estimated to have a failure rate, when ideally used, of 0.3%. Likewise, it is estimated 0.6% in the IUD and 2% in the condom.

The main cause of failure of the withdrawal method is the lack of self-control of those who use it. The wrong time of withdrawal can cause semen in the vulva, which can easily migrate into the female reproductive tract. Some doctors view withdrawal as an ineffective method of contraception.

It has been suggested that the pre-ejaculatory or pre-cum fluid ("Cowper's fluids") emitted from the penis prior to ejaculation, may contain sperm, which would easily pass into the genital tract. However, several minor studies have failed to find viable sperm in precum. Although it is probable that it carries sperm from a previous ejaculation, so it is recommended that the man urinates between sexual relations to clean the urethra of semen remains. It is also recommended to avoid the fertile days of the woman when performing this contraceptive method, for greater efficacy and safety.

Advantages

The advantage of coitus interruptus is that it can be used by people who object to or do not have access to other forms of contraception. Some men prefer it to avoid any possibility of adverse effects of hormonal contraception on their partners. Some women also prefer this method over hormonal contraception to reverse adverse effects such as extreme depression, mood swings, genital dryness, decreased libido. and headaches, among others. It has no direct monetary costs, does not require special equipment, has no physical side effects, can be practiced without a prescription, and has no barriers to stimulation.

Disadvantages

Compared to common reversible methods (IUDs, hormonal contraceptives, and male condoms), coitus interruptus is the least effective at preventing pregnancy. As a result, it is also less cost/effective than many more effective methods, because although the method itself has no cost, users face the expense of a potential pregnancy and childbirth.

The method is completely ineffective in preventing sexually transmitted infections such as HIV, since the pre-ejaculate fluid may contain viruses or bacteria that can infect the partner upon contact with mucous membranes. In some diseases, a reduction in bodily fluids exchanged during sexual intercourse may reduce the likelihood of sexually transmitted disease compared to using no method due to fewer pathogens present.

The method can be difficult for some couples to use as stopping intercourse can leave them frustrated or unsatisfied.

Prevalence

Globally, 3% of women of childbearing age rely on withdrawal as their primary method of contraception. The regional popularity of the method varies widely, from less than 1% on the African continent to 16% in the Middle East (survey data from the late 1990s).

According to the National Center for Health Statistics, of the Department of Health of the United States Government, in that country 56% of women of reproductive age have had a partner at some time in their lives with which he used the withdrawal as a contraceptive method.