Does the Pull-Out Method Work for Preventing Pregnancy?

Any data on the pull-out method or other natural methods not to conceive? Thank you very much.
—Alikea

Generally speaking, the pulling-out method (where a man withdraws his penis before ejaculation) is not thought to be a very effective method of birth control. The issue is that a reasonable proportion of men (based on this small study, about 40%) release viable sperm in pre-ejaculate. As a result, even avoiding ejaculation, sperm may still be deposited in the vagina.

The most common natural approach to fertility control is what is typically called “fertility awareness.” (People sometimes call this the “rhythm method” but this is not an especially helpful term, nor does it accurately capture what the method is). This approach takes advantage of the fact that you cannot actually conceive for most of the month. In the period post-ovulation and pre-menstruation, conception is not possible. In addition, for some period pre-ovulation it is not possible. With good menstrual cycle tracking, couples can avoid having unprotected sex on the relatively small number of days when conception is possible.

There are multiple ways to do this in practice. The simplest is just to avoid a set of five to six days around ovulation based on counting. This works best with a regular cycle. There are also ways to make this much more elaborate: ovulation monitoring, hormone testing, temperature-taking. There are apps for this (of course).

The success of these methods varies, but most importantly there is variation between typical and perfect use. Perfect use of natural fertility-control methods is quite good — perhaps 5 unintended pregnancies per 100 people per year (by comparison, typical condom use is about 18 per 100). Typical use of these methods, though, is more like 24 unintended pregnancies per 100 people per year. That’s much worse than most other methods. Failures are a result of people either mis-estimating the timing or having sex during what they know is a fertile window, for various reasons.

So if you are going to be a perfect user, this fertility awareness method can be quite effective. If not, and you want to prevent pregnancy, other protection is likely necessary.

Side note: For those of you who haven’t read it, I highly recommend Taking Charge of Your Fertility as a primer on all things fertility-related.