Abstinence as a form of contraception

Dear Dr. G,

My wife and I have been married for 13 years and we have two amazing children. We are very happy now and not planning to have more.

Like most couples, we enjoy our intimacy. However, in the last two years, I must say having sex is just very stressful.

We talk a lot about family planning, and never really agree on what to do. Both my wife and I do not enjoy the use of condoms, as it just feels so unnatural and also dampens the sensitivity during sex.

My wife had tried the pills before but was rather frustrated when she put on weight with the medication.

Since we were both not keen to take charge, my wife got pregnant last year but that ended in a miscarriage.

Last month, my wife had a missed period. Thankfully, it was a false alarm again.

I am really terrified and would like to have a better solution for contraception.

So far, we have been trying abstinence as a form of contraception.

I would like to put Dr. G on the spot for his opinion on abstinence as a form of contraception.

Can you tell me what exactly is the success rate of abstinence as a form of contraception?

What if I continue to have sex, but avoid my wife’s fertile period?

Lastly, what if I choose not to have total abstinence, but to ejaculate outside of the vagina?

Really look forward to your response.

Regards,

Stressed

Abstinence can mean different things to different people. True sexual abstinence means not having sexual intercourse at all. For some individuals, abstinent means not having vaginal intercourse, but engaging in other sexual activities, such as anal and oral sex.

Sexual activity that cannot lead to pregnancy is also defined as “outercourse”. Although this is not 100% effective at preventing pregnancy, it is still possible for sperm to reach the vagina resulting in pregnancy. Additionally, it is still possible to contract STIs through nonvaginal intercourse, including anal sex and oral sex.

Pure abstinence works as an effective form of birth control by eliminating all chances of sperm fertilising an egg. Unlike other forms of birth control that work to prevent pregnancy regardless of the exchange of sexual fluids, abstinence prevents semen from entering the vagina.

The compliance of abstinence as a form of contraception is well recognised to be poor, therefore a hopeless form of contraception. Abstinence can also be referred to as having intercourse outside of the fertile period or having sexual intercourse without ejaculating in the vagina. Unlike total sexual abstinence, this method is not 100% effective at preventing pregnancy.

The withdrawal or the pulling out technique is a maneuver of ejaculation outside the partner’s vagina, just at the point of achieving climax. This is the most “natural” and one of the commonest forms of birth control adopted by couples for the prevention of pregnancy. The technique is also called coitus interruptus, and only achievable if the ejaculation is precisely timed to occur outside the vulva or vagina.

The famous sexologist in the sixties, Master and Johnson observed pre-ejaculate contains enough sperm to cause pregnancy. Therefore, it has been long proposed that pulling out is an ineffective form of contraception. However, in recent years, some studies have revealed that pulling out could be almost as effective as condoms in pregnancy prevention.

Two publications that demonstrated the absence of sperm in the pre-ejaculate were closely scrutinised by researchers. The critics pointed out the samples of pre-ejaculate were analysed after two minutes, when most of the semen had already dried up and contained no viable sperm.

To further evaluate the matter, another group of experts assembled 27 male volunteers and analysed the pre-ejaculate within two minutes after producing them. The study found that the samples from 41% of the subjects contained sperm, and as few as 1 million and as many as 35 million were detected.

On one hand, the study revealed that sperm can leak into the pre-ejaculatory fluid prior to climax,but on the other hand many experts also believe the positive samples may actually be due to volunteers submitting their ejaculate instead, as they may be too embarrassed about not producing the proper amount of pre-ejaculate.

The only guaranteed form of contraception is total abstinence. However, various “variations” of abstinence such as “outercourse”, intercourse outside the fertile period and pulling-out technique are less effective, but commonly practised with hopes the method is nearly as effective as absolute abstinence.

Undoubtedly, for couples who have completed the family and are adamant not to have more children, the stress of unwanted pregnancies can be hard on the relationship.