Pull-out method: How effective is it, risks & what to know
Iona Nelson
Maja Garbulinska
Follows NC° Editorial Policy
At Natural Cycles, our mission is to empower you with the knowledge you need to take charge of your health. At Cycle Matters, we create fact-checked, expert-written content that tackles these topics in a compassionate and accessible way. Read more...
Key takeaways
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The pull-out method is when, during sex, the penis is removed from the vagina before ejaculation, to prevent pregnancy
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It is only 80% effective with typical use, lower than other forms of birth control
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It can be difficult to time pulling out effectively, and there is also a risk of pregnancy from pre-cum or from ejaculate landing near the vaginal opening
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We don’t recommend using the pull-out method to prevent pregnancy, but it still remains popular due to its availability. If you want to use the pull-out method, it’s best to use it alongside another form of birth control, such as condoms
Withdrawal, also known as the pull-out method, is often used as a form of birth control. A study of US women aged 18-39 found that around one-third of women will use the pull-out method at least once in the last 30 days [1]. Unfortunately, it is also one of the least reliable methods for preventing pregnancy. But what makes it unreliable? In this article, we will look at how the pull-out method works, the advantages and risks of using it, and how you can increase your chances of preventing pregnancy whilst using it.
What is the pull-out method?
The pull-out method, also known as the withdrawal method, is one of the oldest forms of birth control, where the penis is completely removed from the vagina before ejaculation to prevent pregnancy [2]. While it sounds simple, this is easier said than done, and even if you use the pull-out method correctly, there is still a risk of pregnancy.
How does it work?
To use the pull-out method, the penis must be removed entirely from the vagina before the male reaches orgasm. It is also crucial that no ejaculate lands on or around the vulva. Though it is very rare, sperm cells around the vaginal opening may still make their way into the vagina and lead to pregnancy (sometimes referred to as a splash pregnancy) [2, 3]. Therefore, the penis should ejaculate away from the vagina and vulva. Your partner should also pee before sex to get rid of any sperm that may be lingering on the penis, and both partners should clean their hands and toys before putting them near the vagina again.
How effective is the pull-out method?
The pull-out method is one of the least reliable methods of contraception, mainly due to the high risk of imperfect use. With perfect use, the pull-out method is 96% effective â but this is very difficult to achieve. With typical use, its effectiveness drops to 80% [4].
What are the chances of getting pregnant using the pull-out method?
Based on typical use, 20 out of 100 women will get pregnant within a year of using the pull-out method [4]. The chance of getting pregnant increases when the pull-out method fails, including when:
- The male doesnât pull out in time and ejaculates inside the vagina
- Pre-cum gets inside the vagina during intercourse
- Ejaculate gets inside the vagina in another way (e.g., if it's on hands or sex toys)
If youâve recently had sex and are worried about a potential pregnancy, you can take emergency birth control up to five days after unprotected sex.
Does the pull-out method work when not ovulating?
There are certain days during your menstrual cycle when you are fertile and at high risk of pregnancy, and others when you are not. To understand when your fertile days are, letâs look at how pregnancy occurs.
For pregnancy to happen, a sperm cell must fertilize an egg cell. Ovulation is the release of a mature egg cell that lives for 12-24 hours [5]. It is only during this window that the egg cell can be fertilized. However, sperm can survive in the female reproductive system for up to five days [6]. Because of this, your fertile window (the days when sex can lead to pregnancy) lasts for six days: the five days before ovulation, plus the 24 hours the egg cell can survive [7].
You have a high risk of getting pregnant during the fertile window. Outside of this, you are not fertile, and sex will not lead to pregnancy. So in theory, if youâre having sex outside the fertile window, itâs not possible to get pregnant regardless of whether your partner pulls out during sex, or not.
But there is a caveat. Determining your fertile (and non-fertile) days is a tricky process that has traditionally involved over-generalization about cycle length and complicated temperature and cervical mucus tracking. Natural Cycles can take that work out of your hands. The NC° app combines fertility-awareness methods, temperature biomarkers, and its one-of-a-kind algorithm to pinpoint ovulation and your fertile window accurately. This type of non-hormonal birth control is 93% effective as non-hormonal birth control with typical use and 98% effective when used as intended [4].
Why do people use the pull-out method?
Though it is not a reliable method of birth control, there are several reasons that individuals may choose the pull-out method at some point during their fertile life.
- Back-up option: Many women will opt for the pull-out method as a back-up option to other fertility methods. For example, if they are using birth control pills, they may also choose to use the pull-out method to reduce their risk of pregnancy further [1].
- Cultural reasons: Some cultures frown upon or forbid the use of certain contraceptives; with a limited number of options available, the pull-out method may become the chosen way to avoid pregnancy [8].
- Accessibility: Most types of contraception cost money to make and provide, while in many countries, this is covered by healthcare or insurance. The pull-out method is always free, making it very accessible. It is also the most readily available, often relied upon when there are no other contraceptive options available at that time. For example, if you have forgotten a condom. It is likely also used when there is a lack of knowledge regarding contraceptive options or pregnancy risk.
- No side effects: Using hormonal contraceptives such as the pill or IUD runs the risk of side effects, whereas the pull-out method doesnât alter the body with hormones or devices
- Family planning: Many women choose to use the pull-out method instead of hormonal birth control if they are planning to start a family in the near future, as there can sometimes be a delay after stopping hormonal birth control (especially the birth control shot) before fertility returns to normal [9].
What are the disadvantages?
Most of the advantages of the pull-out method relate to personal preferences and circumstances. However, the disadvantages can directly impact pregnancy risk and sexual health.
- No STI protection: The pull-out method does not protect against sexually transmitted infections (STIs) such as chlamydia [2].
- Hard to control: Effectiveness relies on the male partnerâs ability to know their body and when they are going to ejaculate. This can take a lot of practice and be difficult to control in the heat of the moment [10].
- Risk of pregnancy from pre-cum: Though pre-ejaculate (or pre-cum) contains fewer sperm cells than ejaculate, there is still a risk of pregnancy, as only one sperm cell is necessary for fertilization. More research is needed, as studies report widely varying estimates ranging from 17% to 41% of participants showing sperm in pre-ejaculatory fluid [11, 12].
- Interrupts sex: Controlling ejaculation and concentrating on pulling out at the right time can interrupt sex and reduce the enjoyment for both partners.
- High level of responsibility: The responsibility is on the partner with a penis to withdraw at the right time, and they are also the partner who does not carry the risk of pregnancy. Itâs important to have strong communication with your partner and a mutual understanding of the importance of preventing pregnancy, so the pull-out method can be used effectively.
Best way to use the pull-out method (if you have to!)
We do not recommend the use of the pull-out method as your primary contraception. However, if you choose to use this method, there are steps you can take to reduce the risk of pregnancy and improve your experience.
Use it as a backup only
The most effective way to use the pull-out method is as a backup only, and use another form of birth control at the same time. This increases your chances of preventing pregnancy, whilst still enjoying some of the benefits of the pull-out method. You can choose a barrier method (such as condoms) for additional STI protection, hormonal options (such as the hormonal IUD or the pill), or a hormone-free solution like Natural Cycles, which helps you track your cycle and know when you are fertile. If you choose to track your cycle, avoid using the pull-out method on your fertile days, as you still risk getting pregnant. Instead, you can opt for alternative contraception methods, different types of sex, or abstinence instead.
Keep emergency contraception to hand
Emergency contraception, or emergency birth control, prevents pregnancy after sex has occurred. It is less effective than long-term birth control methods, but can act as a backup [13]. Due to the risks of the pull-out method, you may wish to keep emergency contraception to hand in case the pull-out method does not go to plan.
Levongestrel, a type of morning-after pill, is usually available from your local pharmacy, sexual health clinic, or healthcare practice to purchase in advance, should you need it. Other forms of emergency contraception are only available on prescription.
Remember, emergency contraception is more effective the sooner you take it. Seek advice as soon as possible if you think you are at risk of pregnancy after having sex.
Regularly test for STIs
The pull-out method does not protect you from sexually transmitted infections (STIs), such as chlamydia or gonorrhea. Only barrier methods of contraception, like condoms, can protect you from STIs [14]. If you are using the pull-out method regularly without barrier contraceptives, make sure you have regular sexual health screening, especially when you are with a new partner. You can do this at your local family planning or sexual health clinic. If you think you have an STI or are showing any symptoms, abstain from sex until you have spoken to a healthcare provider, as STIs can be passed from person to person through sexual contact [15].
Communicate with your partner
Using the pull-out method requires trust with your partner, as the onus is on them to withdraw at the correct time. Communicate with each other about what contraception is being used (if any), the reliance on the pull-out method, and the risks associated with it. This encourages a shared responsibility approach and is crucial to gaining consent.
Practice good hygiene
Always wash your hands and sex toys after ejaculation, and before any further sex, to ensure no sperm cells can make their way into the vagina. The male partner should also pee before sex, to get rid of any sperm inside the urethra and around the tips of their penis.
Feel in control with Natural Cycles
Natural Cycles offers a non-hormonal alternative to traditional contraceptives that helps you know which days are safe to have unprotected sex. In the NC° app, non-fertile days will appear green. These are the days you donât have to use additional contraception â or even pull out! â since youâre not fertile that day. Days when it is possible to get pregnant will show up red, indicating that you need to use additional contraception or abstain from sex (we do not recommend using the pull-out method on Red Days, due to the risk of pregnancy). Natural Cycles also has a partner view feature that lets your partner see a restricted version of your app, so they know which days are non-fertile and safe to have unprotected sex, helping both of you feel informed about pregnancy risk.
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