Unprotected Sex Without Ejaculation

Unprotected Sex Without Ejaculation
HIV Risk Without Ejaculation During Sex

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

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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.

Pulling out before ejaculation does not prevent the transmission of HIV. Pre-seminal fluid contains roughly as much HIV as semen. And, even though fluid volumes tend to be smaller, there may be enough to cause an infection. Factors like a high viral load, having an STI, or engaging in anal sex can increase the risk.

If you don't use external or internal condoms consistently, consider starting pre-exposure (PrEP) to reduce your risk of acquiring the virus. If you have HIV, you can substantially reduce the risk of transmission by consistently using antiretroviral therapy and maintaining an undetectable viral load.

If you are concerned that you've been exposed to HIV, don't wait to get tested. Instead, head to your nearest clinic to request post-exposure prophylaxis (PEP) . This is a strategy in which antiretroviral drugs are taken for 28 days after exposure to avoid an HIV infection. 12

PEP needs to be started no later than 72 hours after possible exposure, ideally within 48 hours. A rapid HIV test is given beforehand to ensure you don't have HIV. Another HIV test is given afterward to confirm whether the infection has been prevented. 12

There are several key ways to avoid HIV, including limiting your number of sex partners, using external or internal condoms every time you have sex, and avoiding sharing needles. If you are HIV-positive, it is important to take your medications correctly to keep your viral load undetectable. Your partner can also take PrEP to reduce their risk of getting HIV. 13
HIV is treated with antiretroviral drugs. Lifestyle changes can also keep you strong and help you avoid infection. This includes quitting cigarettes, eating a healthy diet, exercising regularly, and keeping up with routine HIV checkups. 14
Get information on prevention, symptoms, and treatment to better ensure a long and healthy life.
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Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review . AIDS . 2014;28(10):1509-1519. doi:10.1097/QAD.0000000000000298
Politch JA, Mayer KH, Anderson DJ. HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART . AIDS. 2016;30(12):1899-1903. doi:10.1097/QAD.0000000000001130
Vasan SS. Semen analysis and sperm function tests: how much to test? Indian J Urol. 2011;27(1):41-48. doi:10.4103/0970-1591.78424
Kariuki SM, Selhorst P, Norman J, et al. Detectable HIV-1 in semen in individuals with very low blood viral loads . Virol J. 2020;17:29. doi:10.1186/s12985-020-01300-6
Lackner AA, Lederman MM, Rodriguez B. HIV pathogenesis: the host . Cold Spring Harb Perspect Med . 2012;2(9):a007005. doi:10.1101/cshperspect.a007005
Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion . J Acquir Immune Defic Syndr . 2010;53(4):537-543. doi:10.1097/QAI.0b013e3181c3ef29
Pasquier C, Walschaerts M, Raymond S, et al. Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy . Basic Clin Androl. 2017;27:17. doi:10.1186/s12610-017-0063-x
Jin F, Jansson J, Law M, et al. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART . AIDS . 2010;24(6):907-913. doi:10.1097/QAD.0b013e3283372d90
Centers for Disease Control and Prevention. PrEP .
Centers for Disease Control and Prevention. Post-exposure prophylaxis (PEP) .
Sauka M, Selga G, Silova A, Westermarck T, Latvus A, Atrosha F. Impact of CoQ10, L-carnitine and cocktail antioxidants on oxidative stress markers in HIV patients — mini review and clinical trial . In: Pharmacology and Nutritional Intervention in the Treatment of Disease .
National Institute of Allergy and Infectious Diseases. U.S. Department of Health and Human Services. HIV wasting syndrome .
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I just had unprotected sex for like 5 mins on the last day of my period, and my partner had pre-cum before we had sex, is there a highly risk that I can get pregnant?
originally written 10.07.2007 • updated 01.21.2014 •
Your body doesn't really care how long intercourse goes on for.
Whether it's 30 seconds or fifteen minutes (and it's worth mentioning that five minutes of intercourse is about average, so that's not a short period of time for that activity), what your body cares about if it has been exposed to viable sperm , as well as any diseases or infections. And all of those things can, and often do, easily happen within five minutes of intercourse.
What we know about pre-ejaculate is that when sperm is likely to be in it is when a male has not urinated before sexual activity, or after any ejaculate or pre-ejaculate. Given it doesn't sound like that happened, and that you were exposed to pre-ejaculate -- and understanding that pre-ejaculating isn't something that just happens once, but often throughout arousal and/or intercourse, and neither partners will usually feel it during intercourse -- you may have had a low risk of pregnancy . I say low, because given far less sperm are in pre-ejaculate than in full-ejaculate, it does present a lower risk. However, people have become pregnant this way, and if a woman was in a fertile period during that exposure, her risk would be greater.
In general, it is NOT very likely that you were ovulating the day before you expected your period. Rather, if, indeed, it was the day before your period, we can generally agree that you were not in a fertile period.
However, if you really do not wish to become pregnant, we'd still advise emergency contraception for any instance of unprotected intercourse. You can use that within 120 hours (five days) of your risk, but the sooner it is used, the more likely it is to be effective. It might be wise to just go and get it now: by the time you get it, if your period really is due within one day, you may get that period and thus, clearly have no need for the EC. But then you'll also have a pack around should you ever need it again, so it's a win-win situation.
Too, you've also potentially been exposed to any number of STIs. I know that seems like less of a big deal, but it's really not: some STIs can change the course of your life just as much as a pregnancy can, especially for those that go unnoticed and untreated, as well as for the few which are potentially fatal. Statistically, you're actually more likely to wind up with one of those than you are to wind up pregnant. Infections are something you can't prevent after the fact. But you and your partner should schedule a screening for around a month from now, and always be sure to get those every year thereafter. All sexually active people should have those tests yearly, even those of us who do always practice safer sex .
You might know this already, but just in case you don't: withdrawal isn't an effective method of birth control , especially for younger people, and it does nada when it comes to reducing the risks of sexually transmitted infections . So, if you and your partner aren't using condoms, it's time to start. If you're not using them consistently, it's time to change your habits so that you are. Condoms can ONLY be fully effective when they're not only used properly, but used consistently -- as in, every time -- and for all, not just some, genital contact, from start to finish. If the two of you are having a tough time being sexually responsible in this way, it might be time for a talk about taking a break from sex until you can be. If your partner isn't being supportive about using condoms, then you'll need to state and set a clear limit, that from here on out, it's no glove, no love: he needs to use a condom every time, and if he doesn't want to at a given time, then you won't have sex at that given time.
Here are a few more links for your reference:
Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.
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Question posted by liana1027 on 21 May 2012
Last updated on 23 February 2020 by Anonymous
Hello, I just had sex for the first time with my boyfriend and it was unprotected. I just wanted to know that if he didn't ejaculate can I still become pregnant from pre ejaculation? We didn't have sex for very long only a couple minutes because I was scared, I just wanted to know what I should think/know and this point
There is a small risk of pregnancy, but it’s not as high as ejaculation in the vagina. Before ejaculation, all penises can leak fluid called pre-ejaculate. Pre-ejaculate does not contain sperm but it may pick up sperm from a previous ejaculation as it passes through the urethra. This could cause pregnancy. If you are concerned about unintended pregnancy you may want to consider taking emergency contraception (EC) also called the morning after pill. EC is one of the safest and most effective ways to prevent unintended pregnancy after unprotected sex. It is effective if started within 120 hours (five days). If started within 72 hours, EC can reduce the risk of pregnancy by 75-89 percent. In the U.S. the emergency contraceptive pill can be obtained over-the-counter (OTC) without a prescription, identification or age restriction. Plan B One Step and Next Choice One Dose are examples of EC.
Can I ask a question too? Very similar.. Please don’t judge... I found out I am Pregnant on February 17th.. January 17th I had sex with someone who we’ve been trying to conceive for quite some time but no luck- he came inside.. January 18th my friend and I had sex but he did not even ejaculate and I do not believe he did at all that day. Could the baby still possibly be the guy who did not come close to ejaculating inside? Freaking out.
I have similar question, in my case my husband and I have sex but he didnt ejaculate, now i am late for 5 days.. is there possibility I got pregnant? Will be happy if I did.
Hi, So my boyfriend and I had sex for the first time few days ago. He used a condom and didn’t ejaculate. But I’m freaking out thinking I could be pregnant. Is there a possibility even after using protection?
So... I had "sex" I'm not even sure what it was really because it wasn't sex. But he never cam and I was wondering even if he rubbed his penis on my vagina without a condom and tried to stick it in but couldn't..and then I freaked out so we stopped.. could I get pregnant?
Yes you can, I conceived in December 2011 the sex lasted 5 minutes and since I had only lost my virginity a few months prior it was difficult for proper penetration so you can say It was only the tip, he pulled out, but I still managed to get pregnant from the pre-ejaculation we were both so shocked, on the plus side our son is a healthy, happy bubbly 5 year old.
Absolutely! Use protection, when both parts work... you run the risk of getting pregnant.
I have a similar question my boyfriend and I started having sex about two months ago I was a virgin before him and every t
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