Dear Dr G,

My wife and I are in our early forties and have two teenage kids. We are both at the peak of our careers and look forward to the kids leaving for college soon.

As our lives begin at forty and we are getting busy in the bedroom again, we need to start thinking about contraception.

Clearly, having another baby at our age would be disastrous.

We initially used oral contraceptive pills. As my wife gets older, the pills seem to have caused more side effects.

On the other hand, condoms are a nuisance at my age, and I experience erectile dysfunction when I put one on.

We are currently risking it with the withdrawal technique and I just fear one day the withdrawal technique will fail us and I will need to deal with fatherhood from scratch again.

In the spirit of Father’s Day on Sunday (June 15), I dare to put Dr G on the spot for the scientific data supporting the withdrawal technique as a form of contraception. How should a man practice the art of coitus interruptus?

What exactly is the probability of getting pregnant by pulling out prior to ejaculation? How can a man improve the probability of certainty in such uncertainty?

Certainly yours,

Pulling Out Paul

The documentation of coitus interruptus in literature for avoiding pregnancy has existed for 2,500 years in ancient Greek and Roman civilisations.

The withdrawal of the penis from the vagina prior to ejaculation to avoid insemination, as a method of birth control, is known as coitus interruptus, as this interrupts the process of penetrative sex.

Colloquially, this form of contraception is referred to as rejected sexual intercourse, withdrawal, or pullout techniques. The goal of this contraceptive method—preventing sperm from entering the vagina—may not always be successful.

Despite the development of modern contraceptives, the withdrawal method remains popular worldwide. A 1991 survey estimated 38 million couples worldwide use the withdrawal technique for birth control. According to the 2014 National Survey of Family Growth in the United States, 8.1% of women use this method. Therefore, the withdrawal technique is a commonly accepted method of contraception worldwide.

The withdrawal method is attractive to sexually active couples for many reasons. It imposes no direct monetary cost, requires no artificial devices, needs no prescriptions, and has no side effects.

However, users face significant chances of unwanted pregnancies and potential abortions. This method is also inadequate for protection against sexually transmitted infections (STIs). How certain couples can be about pulling out to prevent pregnancy remains a hot subject of debate.

In one study, couples using coitus interruptus correctly can expect failure rates of 4% per year. This compares with failure rates of 2% and 0.3% for condoms and intrauterine devices (IUDs), respectively.

Other population studies have less optimistic failure rates, ranging from 15-28% per year. Although the figures may attract some, data reveal that for women with no previous pregnancies, the failure rate of the withdrawal technique is 8.4% over twelve months. This can increase to a 27% failure rate for women who have had two previous pregnancies.

Such high failure rates of the withdrawal method can be associated with pre-ejaculatory fluid that may contain spermatozoa, compromising the effectiveness of pulling out, regardless of timing. On a brighter note, there are suggestions that viable sperm are retained sperm from previous ejaculations. Therefore, men urinating between ejaculations to clear sperm may reduce the probability of conception with a higher degree of certainty. It might be wishful thinking to presume a forty-year-old can ejaculate more than twice in a row.

In many ways, conception following intercourse is not an exact science.

Enhancing or eliminating the probability of insemination requires the art of using science to eliminate the probability of viable sperm to have some degree of certainty. Many fathers are enjoying Father’s Day on Sunday (June 15) with the seeds of their love, but fearing risks of new fatherhood by pulling out on time.

When Dr G is put on the spot by a dad with the fear of uncertainty, his response is: “Coitus is the art of certainty, and the interruptus is a science of probability.” Therefore, utilising the science of vasectomy, coitus uninterruptus will be guaranteed without the interruptions of uncertainty. On that note, happy Father’s Day to all the great dads out there!