Coitus interruptus

Coitus interruptus, also known as withdrawal or the pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to orgasm (and ejaculation) and then directs his ejaculate (semen) away from the vagina in an effort to avoid insemination. Coitus interruptus, also known as withdrawal or the pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to orgasm (and ejaculation) and then directs his ejaculate (semen) away from the vagina in an effort to avoid insemination. This method of contraception, widely used for at least two millennia, is still in use today. This method was used by an estimated 38 million couples worldwide in 1991. Coitus interruptus does not protect against sexually transmitted infections (STIs/STDs). Perhaps the oldest documentation of the use of the withdrawal method to avoid pregnancy is the story of Onan in the Torah. This text is believed to have been written down over 2,500 years ago. Societies in the ancient civilizations of Greece and Rome preferred small families and are known to have practiced a variety of birth control methods.:12,16–17 There are references that have led historians to believe withdrawal was sometimes used as birth control. However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries, and ineffective, such as amulets).:17,23 After the decline of the Roman Empire in the 5th century AD, contraceptive practices fell out of use in Europe; the use of contraceptive pessaries, for example, is not documented again until the 15th century. If withdrawal was used during the Roman Empire, knowledge of the practice may have been lost during its decline.:33,42 From the 18th century until the development of modern methods, withdrawal was one of the most popular methods of birth-control in Europe, North America, and elsewhere. Like many methods of birth control, reliable effect is achieved only by correct and consistent use. Observed failure rates of withdrawal vary depending on the population being studied: studies have found actual failure rates of 15–28% per year. In comparison, the pill has an actual use failure rate of 2–8%, while intrauterine devices (IUDs) have an actual use failure rate of 0.8%. Condoms have an actual use failure rate of 10–18%. However, some authors suggest that actual effectiveness of withdrawal could be similar to effectiveness of condoms, and this area needs further research. (See Comparison of birth control methods.) For couples that use coitus interruptus correctly at every act of intercourse, the failure rate is 4% per year. In comparison, the pill has a perfect-use failure rate of 0.3%, IUDs a rate of 0.6%, and condoms a rate of 2%. It has been suggested that the pre-ejaculate ('Cowper's fluid') emitted by the penis prior to ejaculation normally contains spermatozoa (sperm cells), which would compromise the effectiveness of the method. However, several small studies have failed to find any viable sperm in the fluid. While no large conclusive studies have been done, it is believed by some that the cause of method (correct-use) failure is the pre-ejaculate fluid picking up sperm from a previous ejaculation. For this reason, it is recommended that the male partner urinate between ejaculations, to clear the urethra of sperm, and wash any ejaculate from objects that might come near the woman's vulva (e.g. hands and penis). However, recent research suggests that this might not be accurate. A contrary, yet non-generalizable study that found mixed evidence, including individual cases of a high sperm concentration, was published in March 2011. A noted limitation to these previous studies' findings is that pre-ejaculate samples were analyzed after the critical two-minute point. That is, looking for motile sperm in small amounts of pre-ejaculate via microscope after two minutes – when the sample has most likely dried – makes examination and evaluation 'extremely difficult'. Thus, in March 2011 a team of researchers assembled 27 male volunteers and analyzed their pre-ejaculate samples within two minutes after producing them. The researchers found that 11 of the 27 men (41%) produced pre-ejaculatory samples that contained sperm, and 10 of these samples (37%) contained a 'fair amount' of motile sperm (i.e. as few as 1 million to as many as 35 million).This study therefore recommends, in order to minimise unintended pregnancy and disease transmission, the use of condoms from the first moment of genital contact.As a point of reference, a study showed that, of couples who conceived within a year of trying, only 2.5% included a male partner with a total sperm count (per ejaculate) of 23 million sperm or less.However, across a wide range of observed values, total sperm count (as with other identified semen and sperm characteristics) has weak power to predict which couples are at risk of pregnancy.