Bareback No Pull Out

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Women have more contraceptive options than ever. So why are many of them all about withdrawal?
- Kelly Blanchard, president of Ibis Reproductive Health
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Senior Wellness & Parenting Reporter, HuffPost
In many ways, 2016 is an exceptionally good time to be a woman in need of birth control. The IUD, a method that works more than 99 percent of the time, is more popular than ever; birth control is covered under the Affordable Care Act ; and in a few states, pharmacists can now give women a full year's worth of the pill without a doctor's prescription. Women's access to a range of reliable contraceptive options is arguably the best it's ever been.
Why, then, do many straight women still turn to the "pull-out method," the world's oldest, most rudimentary form of birth control?
Estimates suggest that nearly 60 percent of American women have relied on their partners to withdraw before ejaculating at some point in their lives, and around 3 percent of 15 to 44-year-old women are currently using coitus interruptus at any given time -- though researchers believe the actual number is likely much higher. Despite its relative popularity, sex educators tend to dismiss pulling out as outdated and irresponsible -- not so much a contraceptive method as a foolish afterthought. And yet the women who regularly rely on the pull-out method insist that it's not only a good option; it's the best option for them.
"I definitely feel shame from others online about my method of choice," said Rachel, 26, who has been using withdrawal with her partner for more than four years. "People seem to be pretty vocal against it." Rachel feels that women who rely on the method are judged as irresponsible, apathetic and downright negligent.
But perhaps surprisingly, research indicates that pulling out is about as effective as condoms at preventing pregnancies -- though of course, not sexually transmitted infections. The perfect-use failure rate for condoms is around 3 percent; for withdrawal, it's 4 percent. One investigation found that 18 percent of couples who use withdrawal for a year will get pregnant, compared to 17 percent among couples who use condoms, although Planned Parenthood puts the chances of pregnancy higher, saying that 27 out of 100 women whose partners use withdrawal will get pregnant. Of course, neither method comes close being as effective as the birth control pill or IUD, but the numbers do suggest that pulling out suffers from an unfairly negative reputation.
"There are still a lot of health care providers who are like, 'Yeah, but it's not really a method,'" said Rachel Jones, principal research scientist at The Guttmacher Institute, which studies sex and reproductive health.
"Over half of women have had a partner who has used withdrawal, so just the sheer fact that most women are going to be exposed to it is reason to be talking about it more," she added. "Both the pros and the cons."
Jones worked on a 2014 study of more than 4,600 18 to 39-year-old women in the United States that found 33 percent had used withdrawal at least once in the past month, lending credence to the claim that current use estimates are low. (Jones cautioned, however, that her study was not nationally representative.) Notably, she and her co-authors found that many women used withdrawal in conjunction with the pill or IUD (13 percent) or condoms (11 percent), basically as a back-up form of contraception. Which suggests that many of the women who identify as "pull-out users" are actually more vigilant about pregnancy prevention.
“Obviously one of the major benefits is that it requires no prescription, no equipment, and it’s an option that’s right there all of the time.”
Withdrawal is sometimes used in conjunction with "natural family planning" or "fertility awareness-based" methods, in which women track their menstrual cycles -- as well as bodily changes that occur throughout -- in order to determine when they're most fertile. Fertility awareness-based methods have long been viewed as a decidedly crunchy, but the emergence of fertility tracking smartphone apps also suggest there is real interest from a range of women.
But even women who rely specifically on withdrawal as their primary method of birth control disagree with the narrative that they're simply ill-informed or ill-prepared.
"I'm not naive," said Tamara, 26, who has a 7-year-old daughter. "I know it's probably a less effective method, and I still chose it. I was on birth control before, I missed a week, and I got pregnant."
For three years in her early 20s, Tamara used withdrawal with her boyfriend. She's not sexually active right now, but she said she would consider using the method again. Nothing about it feels irresponsible to her. On the one or two occasions that Tamara's boyfriend didn't pull out in time, she took the morning-after pill. She and her ex-boyfriend were very clear on what would happen if they got pregnant (she'd get an abortion), and Tamara had money set aside in case.
"I think that there's a misconception. It wasn't because of laziness," Tamara said. "For me it was access." Tamara was on the pill for years, but then she moved and had to drive 45 minutes to her local clinic once a month -- an ordeal that cost her half a day's work. She didn't use condoms because of a latex allergy that makes her break out in a rash.
Women have a lot of reasons why they opt for withdrawal with their partners. The birth control pill has been widely studied and is very safe, but there are a lot of women who simply prefer not to use hormones, said Kelly Blanchard, president of Ibis Reproductive Health, a non-profit that conducts clinical and social science research. Religious objections are another common reason, she said.
"Obviously one of the major benefits is that it requires no prescription, no equipment, and it's an option that's right there all of the time," Blanchard said.
When discussing pulling out, Blanchard was very clear to point out the risks associated with the method, and to explain that she was not advocating for it. But she also believes the discussion should be more nuanced than pulling out is always bad . In 2008, Blanchard co-authored a research commentary with Jones arguing that for all its flaws, health care providers should do a better job of acknowledging withdrawal as a contraceptive method in order to advise their patients and do a better job of studying how often it is being used. It got a lot of feedback, Blanchard said, more so than any paper of her career.
"I heard a lot of negative reactions from sex educators and health care providers who work with young people who said it's dangerous to suggest that it could be used," she said, "and I heard a lot of comments from young people about having used it."
Julia, 22, is one such woman. She has been using the pull-out method since she lost her virginity as a teenager, after discovering she had a latex allergy that caused her to break out in a localized rash. When she was 19, she had an IUD implanted, but she hated it and had it removed six months later.
Julia isn't in a committed relationship, and is currently sleeping with a few men, most of whom are friends she also has sex with. She gets tested for STIs every three months, and expects her partners to do the same. Julia generally trusts that the men she sleeps with are being honest with her about their STI status, but if she feels at all uneasy, she asks to see their results. And she has had a few partners say they're uncomfortable pulling out, in which case they simply do other things together, like oral sex. Julia prefers it when her partners ejaculate on her chest or butt, which keeps things "kinky" she said -- and her sheets clean.
Julia is a true devotee to the pull-out method, and says that for her, for now, there really are no downsides to it. Maybe three times in her life, her partners have been too caught up in the moment and accidentally ejaculated inside her, and in those cases, she used Plan-B.
"If they don't communicate well, and if they don't let me know they're going to ejaculate, how am I supposed to know?" Julia said. "It's a hard thing to read, and that's why communication is key."
"I know women have different reactions to different types of birth control," she added, "but other options weren't a positive experience for me."
Names have been changed to protect anonymity.
Senior Wellness & Parenting Reporter, HuffPost

My boyfriend always ejaculates in me, unless I tell him specicfically every time "pull out" And it can be that we have sex and I tell him to pull out, and he does then 5 min. later he is ready again, and if I don't tell him to pull out that time he won't. I always say afterwards "why didn't you pull out?" He knows better. We already have a 2 1/2 mo. old daughter together, we live together and talked abt. marriage. I am trying to get a job b/c I want us to be able to get a house, and etc...I can't take the pill and I hate condoms. I just wish he would pull out b/c I am not ready for another baby, which I have told him. What do you think is his problem?

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16 Answers - ( Newest, 10 April 2011)

HIV Risk Without Ejaculation During Sex

Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Ⓒ 2022 Dotdash Media, Inc. — All rights reserved

Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more .

Medically reviewed by
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How do you help prevent HIV transmission?

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9 Things Everyone Should Know About HIV

Risks of Using the Withdrawal or Pullout Method

Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Ⓒ 2022 Dotdash Media, Inc. — All rights reserved

Verywell Health is part of the Dotdash Meredith publishing family.

Lindsay Cook, PharmD is a board-certified consultant pharmacist.

Estimating your risk of HIV is a tricky business. While most people know that HIV is mainly transmitted through sex, does this mean that the risk is the same for all types of sex?

The answer is no. Each type of sexual contact carries its own risk of HIV transmission. Receptive anal sex, for instance, carries a higher risk of infection than receptive vaginal sex. Oral sex has the lowest risk of transmission. 1

But what if the insertive partner pulls out before ejaculation ? Is the risk of HIV less?

The answer to that question is not straightforward or simple. This article aims to explore the factors that contribute to HIV transmission and whether "pulling out" is an effective strategy to prevent HIV. In addition, the article will examine ways to reduce the risk of HIV if external (or "male" condoms) and internal (or "female" condoms) are not used consistently.

You can only get HIV by coming into direct contact with certain body fluids from a person with HIV. These fluids are:

Although pulling out before ejaculation decreases the overall risk of transmission, it doesn't prevent it altogether. Why? Because pre-seminal fluid can contain the virus too.

In people with HIV, pre-seminal fluid is just as potentially infectious as semen, containing roughly the same concentration of HIV. 2 This means that even if the insertive partner pulls out before ejaculation, the receptive partner can still be exposed to HIV through pre-seminal fluids.

Pre-seminal fluid ("pre-cum") contains roughly the same high concentration of HIV as semen. During unprotected (also referred to as "condomless") sex, pre-seminal fluid can potentially cause an infection.

People often consider pre-seminal fluid to be less of a risk with respect to HIV because the volume of fluid released is generally lower than semen. However, there are numerous factors that can increase that risk.

Some men can produce high amounts of pre-cum. This is especially true after a prolonged period of abstinence, in which males can produce up to 6 milliliters, or roughly 1-1/4 teaspoons, of pre-cum. 3

An untreated HIV infection can lead to a high viral load . The HIV viral load is a measure of the number of viruses in a sample of blood, ranging from undetectable to well over a million. A higher viral load in the blood corresponds to a higher concentration of viruses in pre-cum. 4

The risk of HIV from anal sex is high because rectal tissues are delicate and easily broken. This allows the virus to pass directly into the bloodstream.

At the same time, the rectum has only a single layer of cells overlying tissues that are rich in immune cells called CD4 T cells . These are the very cells that HIV targets and infects. Because of this, even a small volume of fluid may establish an infection. 5

Some STDs like syphilis cause ulcers that provide HIV easy access into the body. Others like gonorrhea cause inflammation that draws immune cells, including CD4 T-cells, to the site of infection, giving HIV more targets to infect. These factors can raise the risk of infection.

Studies have shown that having gonorrhea or chlamydia increases your risk of getting HIV by 800 percent. 6

An STI or similar infection can also increase the number of viruses in semen through a process known as viral shedding . The inflammation caused by the infection can speed up the production of the HIV virus in the tissues of the genitals. The viruses are then "shed" into semen and pre-seminal fluid, increasing their infectiousness. 7

Even people with an undetectable viral load in the blood can have detectable HIV in semen and pre-seminal fluid as a result of shedding. 7

Even though the concentration of HIV in the pre-seminal fluid is lower than in semen, certain factors can increase the risk of HIV, including having a high viral load, having an STI, or engaging in anal sex.

In the end, there is no hard and fast rule as to "how much" or "how little" pre-seminal fluid is needed to cause an HIV infection. There are many variables that play a role in determining a person's risk.

While pulling out before ejaculation may reduce the chances of transmission, it does not eliminate it. For example, one study showed that condomless receptive anal sex with ejaculation was found to be approximately twice as risky as condomless receptive unprotected anal intercourse with withdrawal. 8 While the risk of contracting HIV is lower with withdrawal, there is definitely a risk.

If you don't use external or internal condoms consistently, there are ways to reduce the risk of getting HIV or passing it to others:

The current evidence suggests that pre-seminal fluid can transmit HIV. To reduce the risk of infection, you can take the HIV prevention pill (PrEP) if you don't have HIV, or start antiretroviral therapy and maintain an undetectable viral load if you do.

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