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 kids!

Like most couples, we enjoy our intimacy. However, in the last two years, I must say having sex is 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 condom, 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. I tried to persuade her to tie the tubes, but frankly, I am worried about complications and the cost involved.

So far, I have been trying the withdrawal technique for nearly a decade. This worked well for me as I have a good control.

Surprisingly, six months ago, my wife became pregnant even though I was certain I did not ejaculate in her. Luckily, the pregnancy did not last!

I am really sorry to put Dr G on the spot, but can you tell me how safe is the withdrawal technique when it comes to pregnancy and infection prevention?

Is there any way to improve the protection with this technique?

Besides condoms, am I really doomed to have a vasectomy as the ultimate way to prevent future pregnancies? How bad is a vasectomy anyway?

Looking forward to your response.



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 most common form 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.

Although many men successfully avoided pregnancies with the withdrawal technique, such maneuver does not ensure the protection of sexually transmitted infections.

The spread of genital warts and herpes usually occurs with the skin-to-skin contacts, while bacteria and viruses such as HIV, chlamydia and syphilis are present in the pre-cum. Hence, the use of condom is the only method to achieve safe sex!

The famous sexologist in the 1960s, Master and Johnson observed pre-ejaculates contain enough sperms that can 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 sperms in the pre-ejaculate, were closely scrutinised by researchers.

The critics pointed out the samples of pre-ejaculates were analysed after two minutes when most of the semen have already dried up and contained no viable sperms.

To further evaluate the matter, another group of experts assembled 27 male volunteers and analysed the pre-cum within two minutes after producing them.

The study found 41% of the subjects contained sperms, and this can be as few as one million and as many as 35 million detected. On one hand, the study revealed sperms can leak into the pre-ejaculatory fluid prior to climax.

On the other hand, many experts believe the sperm positive samples may actually be due to volunteers’ submitting their ejaculate as they may be too embarrassed of not producing the proper amount of pre-cum.

In reality, the pulling out technique is an effective modality of contraception, especially in combination of the avoidance of fertile intervals of the female partners.

In some men, the availability of the emergency contraception is an additional safety measure just in case the withdrawal was mistimed.

Undoubtedly, for couples who don’t want to have more children, the stress of unwanted pregnancies can be hard on their relationship.

When Dr G is put on the spot about the stress that is caused by coitus interruptus, his view is simply: “The “shortcoming” of the withdrawal technique is simply not worth the stress, and men facing the problem might as well “pull out” of the conundrum and go for the snip!

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