Withdrawal

Why it is not a method

Once sex begins, the male urethra is open. Fluid released before ejaculation travels through this channel. Studies have found motile sperm in some pre-ejaculate samples. In one study, sperm were found in 12.9% of samples; in another, in 41% of men. Even if the sperm count is low, a single sperm is enough for pregnancy.

It is not always possible to predict the moment of ejaculation accurately. Timing errors are common, especially during first sexual experiences, under the influence of alcohol, or when tired. Pre-ejaculate passes while the penis is inside the vagina or at its entrance. Pulling out at the last moment cannot undo this. For this reason, withdrawal is not defined as a method.

Pre-ejaculate and sperm transfer

Pre-ejaculate is the clear fluid that comes from the urethra before ejaculation. It is secreted by the Cowper’s glands. Sperm left over from a previous ejaculation can remain in the urethra and mix with this fluid. Urinating does not clear the sperm completely. At the start of sex, this fluid can reach the vagina. Sperm can stay alive for up to 5 days. The risk is higher around ovulation.

At SoftCare, this transfer is clearly explained. Saying “he only pulled out at the last moment” does not eliminate the risk of pregnancy.

Effectiveness

With typical use, the first-year pregnancy rate is about 20–22%. About 1 in every 5 couples becomes pregnant within a year. Even with perfect use, a rate of around 4% is reported. This rate reflects the chance of sperm in pre-ejaculate and timing errors. With LARC methods, the rate is below 1%. At SoftCare, a practice with such a high risk is not accepted as a method.

STI protection

Withdrawal does not protect against STIs. Pre-ejaculate and semen can carry infections. A condom is needed. If there is a new partner or another risk, STI testing is discussed. At SoftCare, this point is mentioned at every consultation.

Emergency contraception

If there is a risk of pregnancy after sex where withdrawal was used, emergency contraception is explained. The levonorgestrel pill can be used within 72 hours, ulipristal acetate within 120 hours, and a copper, gold or hormonal IUD within 5 days. At SoftCare, these options are discussed in advance. An emergency method does not replace regular protection.

More effective alternatives

At SoftCare, these options take priority over withdrawal:

• Gold IUD: Hormone-free, 5 years, no risk of forgetting.
• Hormonal IUD: For heavy bleeding.
• Contraceptive implant: 3 years.
• Condom: Protects against STIs.
• Combined pill or mini pill: Effective with regular use.

Withdrawal does not replace these methods under any circumstances. At SoftCare, the practice is not listed as a method.

Our approach at SoftCare

At SoftCare Clinic, withdrawal is not accepted as a method. It is clearly explained that the urethra is open once sexual activity begins and that pre-ejaculate can pass into the vagina. The pregnancy rate with typical use is stated as about 20–22%. The gold IUD is our first recommendation. If a patient still relies on this practice, the risk is explained in writing. Adding a condom and emergency contraception options are discussed. If there is an STI risk, testing is planned. Switching to a more effective method is raised at every check-up.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 – Appendix H: Coitus Interruptus.
• 2. Mayo Clinic. Withdrawal method (coitus interruptus).
• 3. Killick SR, et al. Sperm content of pre-ejaculatory fluid. Hum Fertil. 2011;14(1):48–52.
• 4. Patel et al. Low to non-existent sperm content of pre-ejaculate in perfect-use contraceptive withdrawal. Obstet Gynecol. 2024.
• 5. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
• 6. T.C. Sağlık Bakanlığı. Gebeliği Önleyici Yöntemler.
• Note: Rates of sperm detected in pre-ejaculate vary between studies. At SoftCare, withdrawal is not accepted as a method; the gold IUD and other LARC methods take priority. This reference list is for information purposes.

A citation does not mean that SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026