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Many people seem to think that coitus interruptus, also called the withdrawal or pull-out method, is an efficient method of birth control. It can work quite well if a couple puts a lot of work into monitoring the female cycle, but if you use it haphazardly, the withdrawal method can easily lead to pregnancy.

Not only is the withdrawal method not 100 percent efficient as a way of preventing unwanted pregnancy, it also — obviously — fails to protect either partner from sexually transmitted diseases.

The reason why people who want to avoid pregnancy at all costs should not use the pull-out method is that the penis secretes small amounts of semen, commonly called "precum" and also referred to as pre-ejaculate, even before ejaculation. If a couple practices the pull-out method during a woman's fertile window, the likehood of getting pregnant from precum while ovulating are, let's put it this way, much higher than zero. Remember that sperm cells can also survive in the female reproductive tract for a number of days, so coitus interruptus in the days preceding ovulation can also lead to pregnancy.
What is precum?

Precum is a colloquial term for pre-ejaculate, a fluid that the penis releases during intercourse but before the ejaculation. This fluid, also called pre-seminal fluid, is secreted from bulbourethral gland and its purpose is to clear the path for the upcoming ejaculation. The secretion starts when the man is aroused and continues throughout intercourse.

Pre-ejaculate is alkaline in nature, and as it travels through a man's urethra it neutralizes the remaining acidity from the urine he previously passed, so that the path is safe for the sperm, which does not handle acidity well. It also facilitates the passage of sperm by lubricating the urethra. That is a pretty neat system, but the kicker for people who want to avoid pregnancy is this — pre-ejaculate fluids do, also contain some spermatozoa, although not very many.

What are your chances of getting pregnant from precum?

Fortunately, many people now know that precum contains some spermatozoa (sperm cells), which can fertilize an egg and create a pregnancy just like the millions that follow during ejaculation. For this reason, the pull-out method is not considered to be a very safe one. There is a chance a woman could get pregnant with precum.

Note that "freshly produced" precum itself does not contain any spermatozoa. Instead, it picks them up from the urethra, where they may have remained after a previous ejaculation. Since spermatozoa can survive and remain motile (having the ability to move around) in the urethra and on top of the penis, when the pre-seminal fluid picks them up and carries them into the vagina, there is a possibility of fertilization and pregnancy.

One of the best ways to prevent this, aside from having protected sex, of course, is for a man to urinate after he experiences an orgasm. That way, the urine will wash away the remaining spermatozoa and raise the acidity in the urethra.

What is your risk of getting pregnant from precum — or getting someone pregnant this way?

That depends on how you practice the pull-out method, so it's difficult to offer an exact percentage. Some couples simply get carried away with passion and roughly plan to pull out before the climax, sometimes succeeding and sometimes not, but others turn the method into a bit of science. They practice the pull-out method outside of the female partner's fertile window and avoid intercourse entirely during the fertile days.

With typical use — which might include some awareness of the timing of the female partner's ovulation, and practicing the withdrawal method most of the time — around 24 percent of couples will get pregnant over the course of one year. Perfect use, which would include measuring basal body temperature, monitoring cervical mucus, and avoiding intercourse altogether during the fertile window, actually increases the efficiency, with some sources estimating that it's possible to achieve a failure rate of less than one percent. (This is similar to the failure rate of most other forms of birth control.)

To put it simply, the pull-out method does carry a certain risk of pregnancy, and your exact risk depends on how you practice the method. The pull-out method is more effective when combined with other methods, such as the rhythm method — also called natural family planning. This method is suitable for monogamous, STD-free couples who are hoping to prevent pregnancy but who are ready to welcome a(nother) baby if they do get pregnant.

For people who really want to avoid pregnancy, other, more user-friendly, birth control methods are a safer choice, however. You have a lot to choose from — contraceptive implants, injections, intrauterine devices, and condoms can all be more effective, while the pill also requires users to be careful to follow instructions. Some couples combine condoms with another hormonal contraceptive for added safety. If you use another contraceptive method and also practice the withdrawal method, your chances of pregnancy from precum on birth control will go down to nearly zero.

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