Dear Dr. G,

I read with horror your article last week on the possibility of pregnancy from pre-ejaculatory secretion. I wish to put Dr. G on the spot for further clarification.

I am an “uncle” in my mid-40s and have two teenage kids who are a bit of a handful. Needless to say, having another kid now is hardly my priority in life! Our method of contraception was initially oral contraceptive pills. As my wife got older, the pills seem to have caused more side effects.

On the other hand, using a condom is just a nuisance, as the lack on sensitivity is certain to dampen the hardness during sex. At present, we are taking the risk of interrupting climax with a withdrawal technique. After reading your article last week about pre-cum containing sperms, the certainty of my mode of contraception is badly interrupted by fear of uncertainty!

Being a man of science like you, I dare to put Dr. G on the spot for the scientific data supporting withdrawal technique as form of contraception? How should a man practise the art of coitus interruptus?

What exactly is the probability of getting pregnant pulling out prior to ejaculation? And how can a man improve the probability of certainty in the cloud of such uncertainty?

Certainly yours,
Uncertain Uncle

The withdrawal of the penis from the vagina prior to ejaculation to avoid insemination as a method of birth control is known as coitus interruptus. In a more colloquial manner, this form of contraception is referred as rejected sexual intercourse, withdrawal or pullout techniques.

The documentation of coitus interruptus in the literature for the avoidance of pregnancy is noted to be at least 2,500 years old in the ancient Greece and Roman civilizations. Despite the development of modern forms of contraception, the withdrawal method remains one of the most popular methods of birth control. In a 1991 estimates, 38 million couples worldwide are believed to utilise such mode of birth control.

Of course, the withdrawal method is popular form of contraception due to many reasons. It imposes no direct monetary cost, requires no artificial devices, needs no prescriptions and has no side effects.

On the contrary, the user of this method has significant chances of unwanted pregnancies and potential abortions. Such method is also completely inadequate for the protection against sexually transmitted infections (STIs). The big issue remains, how certain can couples be that the “pulling out” method will prevent pregnancy?

In one study, couples using coitus interruptus correctly can expect failure rates of 4% per year. This is in comparison with failure rates of 2% and 0.3% for condoms and intrauterine devices (IUD), respectively. Other population studies have less optimistic rates of failure rates, ranging from 15-28% per year. Indeed, such high failure rates of withdrawal method may be associated with the emission of pre-ejaculatory fluid that may contain spermatozoa, which compromises the effectiveness of pulling out, irrespective of the timing.

There are suggestions that viable sperms are actually retained sperms from the previous ejaculations, hence for men to urinate between each ejaculations to clear the sperms may reduce the probability of conception with a higher degree of certainty. I guess it may be wishful thinking to presume a 40-year-old to ejaculate more than twice in a roll!

One of the fathers of modern Medicine, William Osler, who is also the founder of John Hopkins, once said: “Medicine is a science of uncertainty, and the art of probability!” In many ways, conception following intercourse is not exact science. When Dr. G is put on the spot by a 40-year-old-uncle, having interrupted climax, his response is: “Coitus is the art of certainty, and the interruptus is a science of probability”.

Therefore, if all the uncertain “uncles” out there should utilise the science of vasectomy, coitus uninterruptus would be guaranteed without the interruptions of uncertainty!

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