article

07.28.09

The New Unsafe Sex

A recent study suggests coitus interruptus is an effective form of birth control. The Daily Beast’s Tracy Quan on why the push for pulling out is flawed.

Is coitus interruptus making a comeback? Margaret Sanger must be spinning in her grave.

If you thought the New York Times was joking when they hyped an academic paper that champions the so-called “pullout method” as the next big thing in contraception, you weren’t alone. The Times report refers to an article—“Better Than Nothing or Savvy Risk-Reduction Practice?”—in the June issue of Contraception, the official journal of the Association of Reproductive Health Professionals.

One laddish website is touting the news as a “happy hour fact to amaze your drinking buddies with.”

Rachel K. Jones, the paper's lead author, is a senior research associate at the Guttmacher Institute, a respected think-tank known (until now) for its sane, wonkish approach to sexual health. Jones and her co-authors claim that withdrawal is "almost as effective as the male condom” for preventing pregnancy. The belief that pre-ejaculate fluid contains sperm lacks “supporting evidence,” they tell us. If this means there is never any sperm in such fluid, hooray, but what woman wants to wager her impregnation chances on a lack of supporting evidence?

Even more to the point, the folk wisdom—endorsed by this paper—that withdrawal is a valid method puts women in a very awkward position when discussing contraception with male sex partners. Getting men to take birth control seriously has never been easy. One laddish website is astutely touting the news as a “happy hour fact to amaze your drinking buddies with.”

A man proposing withdrawal instead of latex is one of various landmines a single woman may encounter out there. This “ surprising option” (as the tone-deaf Times headline calls it) is often viewed as caddish. It’s not just that withdrawal is low-tech. Men should know that a woman may be insulted by the suggestion—especially if she's personally opposed to abortion—and women using withdrawal might be ambivalent about pregnancy.

Another tidbit to amaze your drinking buddies with: according to the Contraception authors, couples using withdrawal should be spared “unnecessary levels of anxiety” about the risk of pregnancy.

Anxiety about contraception is both good and necessary. It's like the anxiety you feelabout flying through the windshield of your car that makes you buckle up. Even if there are a few short rides during which you didn’t buckle, do you really want road-safety experts telling you not to worry about it?

One danger is that women will be henpecked by men who now claim that unprotected sex is medically safe. I can’t help but feel that researchers and health care providers who “just kind of dismiss withdrawal,” as Jones puts it, are actually doing us all a favor.

“When this [article] first came out,” Pepper Schwartz told me, “it was a quandary for educators.” A sociologist at the University of Washington, Schwartz is the author of Prime, Finding Your Perfect Match, and numerous other books on sexuality. “Withdrawal may prevent pregnancy, but anyone who works with young people doesn’t like it because of disease.”

Regarding pre-ejaculatory fluid, she says, “One study I saw says there’s no sperm, but it’s not the last word. I’m still a big fan of condoms because this is the only method that keeps out the diseases that can hurt your fertility.”

Beth Fredrick, a longtime health policy analyst, is, to my surprise, also a longtime user of withdrawal. Her husband was “consistently good at it and never made a mistake.” Two people should use withdrawal “only if you both know what will happen” in the event that you become pregnant, she says.

Fredrick also surprised me by discussing the shortcomings of pulling out rather than its benefits, which may explain her long-term success with it. One drawback, she says, is that withdrawal forces a woman to rely on her male partner for successful contraception—and what if his passion gets the better of him? A woman who intends to practice withdrawal with a man could also get carried away, mid-orgasm, causing him to lose control.

If you have to learn how to withdraw correctly, why not devote that skill to refining your condom game?

Charles F. Westoff, a demographer specializing in fertility and family planning at Princeton University's Office of Population Research, says the hype is misleading. "When comparing the effectiveness of condoms and withdrawal, data for 25 countries do not agree with the failure rates in the Contraception article. Why the authors did not look at this is peculiar to me."

Westoff has been studying these numbers for two decades and finds the method unreliable because “there’s a high variability in the failure rates for withdrawal, ranging from 3% in Indonesia to 21% in Armenia.” Worldwide failure rates for the male condom, he says, are more consistent. “The average annual failure rate for the condom is 5%,” says Westoff, “ranging from 1% in Ethiopia to 10% in Azerbaijan."

One selling point offered by advocates of withdrawal is that it’s readily available. Another is cost. Rev. Debra W. Haffner (Unitarian Universalist), author of Beyond the Big Talk: Every Parent's Guide to Raising a Sexually Healthy Teenager, says it’s a good method for the young because “it’s free, it’s always with you, and you don’t have to ask for anyone’s permission to use it.”

I remember how I hated asking permission to start having a sex life. Sure. But is withdrawal really free? Not all teenagers prefer the easy way in. Nor should they all be held to such a low standard. And why assume that sex is more desirable when there’s no cost? It costs money to have sex in a safe, healthy environment—whether that means spending money on a room or having the means to make love at home. Does this mean healthy sex is a privilege?

Contraceptives, lubricant, fresh laundry, and other accessories to a good time, like regular medical care and soft music, require discretionary income. The idea that we would never postpone sex to create the right contraceptive circumstance, that we would use withdrawal just because it’s free, devalues our erotic pleasures. Sex that appears “free” of obligations is often a set-up, an illusion, while the best orgasms are often worth waiting for.

Sex almost always comes with a cost, whether emotional or financial, and when it comes to birth control, you just might get what you pay for.

Tracy Quan's latest novel is Diary of a Jetsetting Call Girl, set in Provence and praised in The Nation as a "deft account of occupational rigors and anxieties before the crash." Tracy's debut, Diary of a Manhattan Call Girl, and the sequel, Diary of a Married Call Girl, are international bestsellers. A regular columnist for The Guardian, she has written for many publications including Cosmopolitan, The Financial Times, and The New York Times.