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Coitus Interruptus Erroneous: Would You Believe That Pulling Out Actually Works?

Withdrawal is one of the oldest forms of birth control. Yet, our gender biases -- along with some very bad science -- have made it taboo.
 
 
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Coitus interruptus, withdrawal, pulling out, raw dog. Of all the names ascribed to the intimate act that is a man removing his penis from his partner's vagina before orgasm, the terminology that best encapsulates the public's perception of it is "Pull and Pray." As in, pull out and pray you don't have a baby. As a form of birth control, the method is largely regarded as ill-thought out -- the last resort of hasty teenagers with access to the family car and several cans of beer. In short, it doesn't work. Except that it probably does.

A recent study conducted by Rachel Jones, senior research associate at the Guttmacher Institute, asserts that research shows the withdrawal method is almost as effective as condoms when used correctly. When used correctly 100 percent of the time, condoms have a two percent failure rate. When used correctly, withdrawal has a four percent failure rate. And Jones is not the first one to the party. In her paper "Better than nothing or savvy risk-reduction practice? The importance of withdrawal," she references another study by an enterprising pair named Deborah Rogow and Sonya Horowitz who came to the same conclusion, which is that pulling out is a hell of a lot better than nothing and that more research should be done on the matter. That was back in 1995. Fourteen years later, Jones is still one of the scant voices requesting more research.

Withdrawal is one of the oldest, most widely used forms of birth control outside abstinence. It's mentioned in the Bible. Some scholars argue that the Prophet Muhammad gave pulling out the thumbs up. So when did coitus withdrawal get the big red "rejected" stamp?

The Catholic Church was one of the first institutions to frown on pulling out. Sperm deserved a shot at the egg, and impeding its journey indicated couples were interested in copulating for reasons other than having a baby. But the tide really began turning against pulling out because, unlike the church, opponents believed users would have a child. The 1900s ushered in new forms of birth control, like diaphragms, and along with it, birth control activists. Margaret Sanger, the champion of birth control in the U.S. and Marie Stopes, her counterpart across the pond, were not fans. In addition to deeming the method unreliable even when used correctly, both felt that men couldn't be trusted to pull out in time. Men were sexual animals who either didn't care enough to pull out, or couldn't.

Sanger and Stopes also subscribed to a belief that was common during the day that pulling out would essentially drive both participants bonkers and lead to any number of health problems. In a report she prepared for the courts in 1917, Sanger includes the writings of Enoch Heinrich Kisch, an Austrian gynecologist who penned one of the, ahem, seminal texts on the dangers of withdrawal, The Sexual Life of Women, in 1910.

Kisch believed that some of the "evil effects" of coitus interruptus lead to "intense hyperaemia of the uterus" and "chronic netritis." Stopes complained that women were deprived of "the beneficial absorption from the seminal and prostatic fluids." (At least one researcher suggested that it was obvious that certain elements of sperm were absorbed through the vaginal walls because its odor could be detected on the breath of women who had recently had intercourse.)

Coitus interruptus was blamed for heart problems, back problems, "congested" urethras, and neuroses. In short, the failure of a man to deposit the proof of his orgasm inside a woman's vagina was a tragedy. And it wasn't just bad news for the guy. The woman's satisfaction was intrinsically tied to the man's. Withdrawing the penis prior to ejaculation circumvented the female orgasm and left her frustrated. While a valid concern for women's need to control their own fertility made birth control the domain of doctors and the medical establishment, it was also coupled with bad science. Natural methods fell to the wayside.  

Broaching the subject of pulling out with nearly anyone inevitably leads to a conversation about pre-ejaculate.

This is quite possibly why the topic shouldn't be raised over a lunch of fried chicken with gravy, but it was. "But what about the precum, it's full of sperm," protested a full-time journalist with a couple of degrees, when discussing the efficacy of withdrawal. Upon being informed that research suggests there is little to no sperm in pre-ejaculate, a chicken wing was summarily dropped in a puddle of gravy and a look of shock replaced that of knowing.

Plug pre-ejaculate, or any of its nicknames, into a search engine with the word pregnancy, and page after page of search results informs the reader that even if the man succeeds in depositing the denouement of his sexual excitement outside the female anatomy, pre-ejaculate brimming with sperm will undo all good works.

Pre-ejaculate, also known as Cowper's fluid, is manufactured in the Cowper's gland (not the testes where semen originates), which is named for its discoverer, seventeenth century anatomist William Cowper. It was impossible for Cowper to know what a large amount of misinformation would be attached to his tiny gland. (He was no stranger to controversy, however. He was accused of plagiarizing chunks of his book Anatomy of the Humane Bodies from a Mr. Govard Bidloo. This controversy spurred the publishing of indignant pamphlets by both men.)

There are actually two Cowper's glands, which are held together and sit in something that sounds more like an It-bag than a part of the body, called the deep perineal pouch. Basically, it's in the butt. The job of these glands is to produce a viscous fluid during sexual arousal. The fluid lubricates the urethra, preparing the way for the semen that will follow. Small amounts of sperm found in precum are most likely picked up by the fluid when a man has recently had an orgasm and not urinated.

It's unclear exactly where the belief in sperm-filled pre-ejaculate originates, but it doesn't seem outlandish after looking at the work of early researchers of reproduction. Sperm reigned supreme. Many of them believed that making humans was a one-stop-shopping affair, with all the vital ingredients packed into the semen. Women were just the incubator. Antonie van Leeuwenhoek, a celebrated Dutch microscope maker and the first person to describe the spermatozoa of humans in November of 1677, went so far as to claim he had even seen nerves, arteries and veins in the stuff. (He later retracted this statement, but similar accounts popped up in other researchers' work.) It's not a great leap to assume that early scientists would ascribe import to anything that leaked from the male reproductive organ. A simple, helpful lubricant couldn't possibly flow from the font of life.

Fast forward to the present day, and all the misinformation and nay-saying about pulling out hasn't changed very much. Human sexuality textbooks used in colleges and written within the last five years still promote the idea that withdrawal doesn't work. "It is entirely possible for a woman to become pregnant," chirps the 2004 edition of Exploring Human Sexualty, "even if her male partner is certain that he "pulled out in time." That is why "withdrawal" as a form of birth control is really not birth control at all!" And really, who cares? What about AIDS? What about men who don't pull out on time? What of the bedspread, for that matter? When other forms of birth control are available, why resort to withdrawal? Maybe it's best for all concerned that everyone continues to think that pulling out doesn't prevent pregnancy.

But misinformation, even when it's spread around for everyone's own good, rarely ends up doing any, especially when it's tangled up with tired stereotypes.

Take for instance, the oft-repeated trope that men just can't be trusted to pull out. Jones, of the Guttmacher study, acknowledges that this is one reason withdrawal has such a bad name. She says, bluntly, "I think it's perpetuated by this idea that men are really sexual and all they want to do is have an orgasm, and you can't trust them to pay attention." In other words, boys will boys.

The same maxim has been used to justify a laundry list of societal ills, from binge drinking to sexual assault. This is not to say that all men can and should be trusted to pull out in time. But what if we actually expected them to? Assuming that all men have the control of boys is especially frustrating when, as Jones points out, "...a lot of women trust their male partners."

The cave-man theory has been a recurring theme in literature about withdrawal from the 1800's into the present, and the reason for its pervasiveness is one that even historians have a hard time putting their fingers on. "If I could answer that question I could be president of the world," says historian John D'Emilio, professor of history at the University of Illinois at Chicago and co-author of Intimate Matters: A History of Sexuality in America. "...When you are writing and researching the history of sexuality it always seems that it's women's sexuality that keeps getting constructed and reconstructed and the model of male sexuality is always the same, that it's just this force waiting to be released."

If men are carefree boys, releasing their force wherever they please, where does that leave women? With a lot of responsibility. D'Emilio points out that after the pill arrived on the scene, "...using something that depends on the guy when you can use something that depends on you really gives withdrawal a bad name." He's right. The burden of not getting knocked up, even today, rests mostly on the one whose getting fertilized. Add this to the belief that pulling out doesn't work and you've got a quick and easy recipe for guilt. In Jone's study, interviewees who use withdrawal nearly ooze contrition. One female who says she uses the method amends her admission with, "...Which I know is, like, the worst thing." Jones explains the apologetic, embarrassed tone this way: "We're told 'If you don't want to get pregnant, you have to use an effective method.' People think it doesn't do any good so they're kind of embarrassed...on one hand they're acknowledging that 'I don't want to get pregnant and I'm relying on this ineffective method that's kind of irresponsible of me'."

In light of the stigma attached to pulling out, why does anyone even bother? "They don't have condoms on hand all the time," surmises Jones, "A lot of women don't like hormonal contraception or can't take it...or they don't like the side-effects, or they have problems trying to take the pill every day or going in to get their ring or their patch prescription refilled." Some people also use the pull out method because they don't have access to other kinds of birth control or for religious reasons. Also, as Jones points out, "A lot of females don't like condoms; a lot of men don't like condoms." And therein lies the rub. Combine the burden of not getting pregnant (irresponsible!) with the suspicion that a woman is using the pull out method because it feels good (slutty!) and you may have uncovered one of the reasons we still tell everyone that withdrawal doesn't work. Instead of absorbing "beneficial prostatic fluids," now women just absorb shame.

When Leeuwenhoek looked into his microscope and saw veins and capillaries, he saw what he wanted to see. He had the big picture at hand (or as big a picture a smudge of seminal fluid can paint) but when he looked closer, he interpreted it through a lens that favored the procreative potential of men over women.

Today, we are armed with a lot more information than the microscope savant, but still see what we want to see. Withdrawal doesn't protect against STIs, making it less than ideal for the one night stand. It can spell disaster for the sexually inexperienced. But it can be a great option for long term couples or people who don't have access to, can't use other forms of birth control, or just don't like to.

And some of all these people, whether health providers, parents, or teachers approve, will use it. Shouldn't they know how it works? Under the microscope, we look at withdrawal and see cave-men and floozies instead of people trying to make choices about how not to have a baby.  Leeuwenhoek wrote in a letter two years after his "discovery" that, "I well remember that before now I wrote similar things...about strings lying intertwined in sperm, an opinion that I now unconditionally reject, having found that this intertwining was merely accidental." Health educators, providers and researchers should take a page out of Leeuwenhoek's letter and admit that withdrawal deserves a second look, and that the reason for its bad reputation might have more to do with the lens than the evidence underneath it.

Andy Wright is a freelance writer in San Francisco. Her work has been published in the SF Weekly and Mother Jones online.