Dear Dr. G,

I am a man in my late thirties enjoying the peak of life.

I am at the height of my career and enjoying the best of my sex life with my wife, and I am blessed with two healthy teenage boys.

Truthfully, both of us are still contemplating the possibility of a girl in the future and therefore not considering sterilization.

However, my wife and I have an ongoing issue with contraception that I am hoping to pick your brain on; she was initially on oral contraceptive pills, but the pills seem to be causing more side effects than before as she gets older.

As for condoms, they are a nuisance as the lack of sensitivity dampens the sensations of sex.

As such, we are using the withdrawal method – and my current mode of contraception is certainly interrupted by fear of uncertainty!

Being a man of science like you, I would like to put Dr. G on the spot for the scientific data supporting early withdrawal as a form of contraception.

Firstly, does pre-ejaculate contain sperm? Secondly, how should a man practice coitus interruptus to ensure less chance of pregnancy?

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

Certainly yours,
Dangerously Living Danny

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 to as the withdrawal or pulling-out technique. The documentation of coitus interruptus in literature for the avoidance of pregnancy, is noted to be at least 2,500 years old and despite the development of modern forms of contraception, the withdrawal method remains one of the most popular methods of birth control. In a 1991 estimate, 38 million couples worldwide are believed to utilize this mode of birth control.

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

However, the user of this method lives dangerously with chances of unwanted pregnancies and potential abortions. Such a method is also completely inadequate for protection against Sexually Transmitted Infections (STI’s).

As such, the big issue remains – how certain can couples be by pulling out to prevent pregnancy?

The biggest obstacles of the withdrawal technique are hampered by the problems of the pre-ejaculate. Pre-ejaculate is also known as pre-seminal fluid or pre- cum. In comparison to semen. It is a clear and colorless viscous fluid secreted by the urethra during sexual arousal. Although the composition is very similar to semen, the presence of sperm in the pre-ejaculate is quite variable amongst normal men. Some studies revealed high concentrations of sperm, and others found the absence of sperm. There have been several small-scale studies, with numbers of subjects ranging from 4 to 23, highlighting no sperm present inthe pre-ejaculate.

On the other hand, two other studies demonstrated viable sperm in pre-ejaculatory fluid in 16% of the participants.

The high failure rates of withdrawal method may be associated with the emission of pre-ejaculatory fluid that may contain spermatozoa, and this compromises the effectiveness of pulling out, irrespective of the timing of pulling out. In one study, couples using coitus interruptus correctly can expect failure rates of 22% per year. This is in comparison with failure rates of 2% and 0.3% for condoms and intrauterine devices (IUD), respectively.

On a brighter note, there are suggestions that viable sperm is actually retained from previous ejaculations, hence if man urinates between each ejaculation to clear the sperm this may reduce the probability of conception with higher degree of certainty. I guess it may be wishful thinking to presume that most men ejaculate multiple times in one go!

One of the fathers of modern medicine and the founder of John Hopkins William Osler once said that “medicine is a science of uncertainty, and the art of probability!” In many ways, conception following intercourse is not an exact science. Enhancing or eliminating the probability of inseminations requires the art of using science to eliminate the probability of viable sperm to have some degree of certainty!

When Dr. G is put on the spot by dangerously living couples who practice withdrawal with the fear of uncertainty, his response is that “coitus is the science of certainty, and the interruptus is the art of probability” Hence, the certainty of science through a vasectomy will guarantee coitus uninterruptus without the danger of interruptions of uncertainty!

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