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Withdrawal gaining favour as birth-control method

"He pulled out."

An admission of "withdrawal" as a method of birth control usually gets the guilty party long stares from her girlfriends, followed by a brisk trip to the local drugstore.

The withdrawal method has long been condemned as lazy, booze-fuelled buffoonery by those who diligently stock prophylactics under the bed and pop birth control for breakfast.

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But some U.S. academics are trying to raise the status of the pullout, deeming it "a legitimate, if slightly less effective contraceptive method" than condoms and diaphragms.

"Withdrawal has a bad rep, but if you look at the research, it substantially reduces the risk of pregnancy," said Rachel Jones, a senior research associate at the Guttmacher Institute in New York.

Dr. Jones is the lead author of Better Than Nothing or Savvy Risk-Reduction Practice? The Importance of Withdrawal, a commentary published this month in Contraception magazine. She and her fellow authors want health-care providers in family planning to start discussing withdrawal with their patients.

Especially since many of them are doing it and keeping mum.

"The majority of women have used it at some point in their life. We need to be talking about it," she said.

The 2002 U.S. National Survey of Family Growth found 56 per cent of a sample of women aged 15 to 44 had used withdrawal at some point in their lives, up from 41 per cent in 1995. Thirty-one per cent of women said they used the method in conjunction with condoms, 19 per cent said they combined it with a hormonal method and 5 per cent said they did it alongside the equally contentious rhythm method or natural family planning.

The commentary in Contraception contends that pulling out is especially effective if couples pair it with other means - including the rhythm method, which involves abstaining from sex or using protection when a woman is at her most fertile in the menstrual cycle.

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"What's interesting is that people are using it somewhat effectively, even though we tell them it doesn't even work," Dr. Jones said.

The authors write that "misperceptions" regarding the method are causing "unnecessary levels of anxiety." They are advocating more research and want health-care providers to recognize the method as a "backup."

They acknowledge the method is powerless against sexually transmitted infections and stress that their commentary is directed at health providers counselling monogamous couples on family-planning issues.

Sheila Dunn, a physician at Toronto's Bay Centre for Birth Control, said that when she asks, women "often" tell her their partners pull out.

"I see couples who have been using withdrawal for years and years, combined with condom use when it's a little bit riskier time of the cycle. Some of them will say, 'Well it's not really a method of birth control.' And I'll say, 'How long have you been using it and you didn't get pregnant?' It's working pretty well for some of them."

Dr. Dunn, who is also an associate professor in the department of family medicine at the University of Toronto, said: "The best method of family planning is the one that the patient wants to use.

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"But we need to be knowledgeable about how to use it, what it means, what the drawbacks are and what it doesn't do for them, so that they can make a really reasoned decision."

Dr. Jones and her fellow researchers - Jenny Higgins at Princeton University's office of population research; Kelly Blanchard of Ibis Reproductive Health at Cambridge University; and Julie Fennell at Central Connecticut State University's sociology department - cite international research, a Kinsey Institute survey and two studies of their own.

The authors say that when it comes to reducing pregnancies, withdrawal rivals even the use of condoms. Failure rates for condoms hover at about 17 per cent, while 18 per cent of couples will get pregnant in a year using the withdrawal method, according to estimates of contraceptive failure from the 2002 national survey, which was based on reports from hundreds of women.

In their own studies, the researchers interviewed 30 U.S. heterosexual couples about contraceptive decision-making. Some respondents admitted they rely on withdrawal, but most said it was a backup method used alongside condoms or the pill.

More than half said they had "problems" with condoms, including reduced sexual pleasure, inconvenience and difficulty using them.

Withdrawal, on the other hand, was seen as less complicated.

As for concerns around pre-ejaculate, which seeps out of the penis before an orgasm, the authors note two studies that suggest the fluid may not contain sperm, but allow that "confirmatory studies are needed."

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