My Boyfriend Pulled Out and Then We Had Sex Again
It starts with an age-onetime question: If a man pulls out before ejaculating, can a woman still get significant?
In bedrooms, basements and the backs of cars worldwide, millions of sexually active humans make choices (or regret them) based on what should be foundational fertility knowledge. Most trusted sources say the answer is yes—it is unlikely but possible that pregnancy will occur, so don't gamble it.
Dig deeper, though, and information technology rapidly becomes unclear exactly where the adventure is coming from. Instead of evidence-based education, y'all'll see some of the most durable misconceptions in sexual and reproductive health. When researchers analyzed a year'southward worth of questions that were submitted to an emergency contraception Web site, they found that almost half of the questions that involved sexual acts "express fear about the pregnancy risk posed by pre-ejaculatory fluid."
Preejaculate—which pretty much everyone calls precum—is the lubricative secretion that is emitted, involuntarily, from the Cowper'due south gland in the penis during sexual arousal. Its task is to create a hospitable ride for sperm that ultimately pass through the urethra during ejaculation. Just whether you query the Cyberspace or an andrology skilful about the fertilizing power of that egg-white goo, you're likely to get an answer to a different question—that is, a annunciation that pulling out is a terrible class of nascence control.
"When nosotros're talking about what's in preejaculate, that's not really the point," said Michael Eisenberg, director of male reproductive medicine and surgery at Stanford University School of Medicine, subsequently I'd asked him the fertilizing-ability question in various ways. "Nosotros know that pulling out is non effective at preventing pregnancy."
The pullout method—alternatively known equally "withdrawing" or "pull and pray" and formally christened in Latin equally "coitus interruptus"—is an ancient course of contraception. The Talmud refers to it every bit "threshing inside and winnowing outside." Globally, it is yet i of the well-nigh commonly used forms of birth control, specially in regions without admission to modern methods. When performed perfectly every fourth dimension, it really has a failure rate that isn't much higher than that of condoms: four pct versus 2 percent, respectively. That ways well-nigh four out of 100 women who rely on the pullout method exclusively will become meaning during one year of use.
But real life is rarely perfect. Some males cannot reliably perceive the imminence of ejaculation and withdraw as well belatedly. Others might emit semen intermittently or over a long period of time instead of every bit a single event, according to a 1970 family unit-planning manual. A lot of men don't realize that the highest concentration of sperm occurs in the first spurt of semen—which can be especially problematic if getting drunk slows downwards their reaction time. Yet others don't pull out in fourth dimension because their pleasure takes precedence over a woman's wellness and well-being. For reasons such as these, the "typical utilize" failure rate of coitus interruptus jumps to between 20 and xxx percent.
People in the reproductive-health field largely dismiss the pullout method because they don't believe men have the ability and willpower to withdraw at the right time, every time. Meanwhile in that location is a shocking lack of research on whether or non viable sperm are actually present in preejaculate.
The all-time style to synthesize the answers I collected from physicians, peer-reviewed journals and educational institutions is this: Preejaculate itself does not incorporate sperm—or possibly it does occasionally, merely perhaps it gets contaminated with sperm that has "leaked" from elsewhere. Plus, there'southward leftover sperm from previous ejaculation. And anyway, Eisenberg says, we should presume that preejaculate "usually has some sperm, which can pb to [contraception] failure."
It is obvious to blame inadequate sex activity teaching for our collective confusion. Just ironically, write the authors of a 2009 Contraception newspaper, "the notion that pre-ejaculatory fluid can cause pregnancy ... seems to accept been introduced by the medical profession itself."
Dispelling a Myth?
Where did the fertile prowess of preejaculate originate? Perhaps it was in 1931, when Abraham Stone—a physician and colleague of Planned Parenthood founder Margaret Sanger—wondered how information technology was fifty-fifty possible for the withdrawal method to neglect: Sperm are made in the testicles and don't route through the Cowper'south gland on their manner out. Stone asked some buddies with microscopes to examine their preejaculate for sperm. Amidst the 24 samples from xviii men, only 4 contained many or a few sperm. In a 1938 volume, Practical Nascence-Control Methods, Stone wrote that these figures were insignificant. Regardless, a "myth" that a handful of sperm in preejaculate makes coitus interruptus unreliable took off, and it was "copied uncritically from one textbook another," according to the 1994 edition of the book Fertility Control.
This myth was popularized by the archetype 1966 textbook Human Sexual Response, by William H. Masters and Virginia E. Johnson, according to the Contraception paper. These pioneering sex researchers "warned of the possibility of pregnancy from withdrawal due to the presence of sperm in secretions of the Cowper'south gland"—a statement that "was manifestly non bear witness-based simply subsequently repeated," the authors write.
The Contraception paper'southward authors besides speculate on why sperm seem to have "boggling authorization" in the eyes of the public. In textbooks and the media, sperm are "oft anthropomorphized as masculine, forceful, competitive, and single-mindedly determined to fertilize the egg against all obstacles," they write. Indeed, the memorable 1989 educational film The Making of Me features cartoon sperm "men" in a literal race for a sexualized egg "woman," fix to a soundtrack that includes Richard Wagner's "Ride of the Valkyries." Additionally, girls frequently larn to be terrified of sperm yet aren't taught how their ain trunk works: A recent survey of 1,000 American women of reproductive age found that 80 percent of them were non able to correctly answer how many days of each cycle they are fertile.
Since Stone's experiment, there has been little incentive to research coitus interruptus at all, partly because dissimilar condoms or intrauterine devices (IUDs), at that place's no contraceptive product to sell. While the pregnancy risk of preejaculate has only been investigated a handful of times, the results challenge popular assumptions and raise new questions.
Here's what the literature tells us: In the early 1990s, a study examined the preejaculate of HIV-positive men to determine if the virus was present. (It was.) An ancillary but "more pregnant" finding described in Contraceptive Technology Update was that "nearly pre ejaculate samples did not contain any sperm and those that did had only modest clumps of a very small amount of sperm which seemed to exist immobile." If a larger study confirmed the results, the article said, it "may dispel the myth that pre ejaculate fluid contains sperm."
Simply tiny studies have taken place since. In a 2003 experiment with 12 Israeli men who gave at least two samples of preejaculate each, scientists examined the secretions under a microscope and found that none of them contained sperm. Another small written report also found no sperm.
Several years ago, researchers in England and the U.Southward. set out to more than rigorously investigate the fertilizing potential of preejaculate, noting that "no study has found motile sperm in the pre-ejaculate." Their paper, published in Human Fertility in 2011, analyzed 40 samples of preejaculate from 27 volunteers. Ten of the volunteers (37 percent) produced samples that included "a reasonable proportion" of motile sperm.
Because some of the men gave samples on multiple carve up occasions, an intriguing pattern emerged: sperm was present in either all of an individual's samples or in none of them. "It would announced from our study," the authors wrote, "that some men repeatedly leak sperm in their pre-ejaculatory fluid while others do not."
They therefore concluded, "it is tempting to speculate that the use of withdrawal as a means of contraception might exist more successful in some men because they are less likely to release sperm with their pre-ejaculate."
Then, in 2016, a larger study of 42 healthy Thai men reported that "actively mobile sperm" were found in only 16.7 pct of the subjects. Unfortunately, the researchers did not collect preejaculate samples on multiple occasions.
To make sense of these conflicting data, I called John Amory, a doctor and professor at the University of Washington, who is known for his research on male infertility and novel forms of contraception. I asked him about the plausibility of this "two groups" concept: the idea that men might either always accept sperm in their preejaculate or never have information technology.
Amory responded with surprise. "See, I didn't even know that," he said about the studies. "We were taught [in medical preparation] that sperm were left over from the last ejaculate." This is a popular theory. Planned Parenthood similarly says that preejaculate "may option up sperm from a previous ejaculation as it passes through a human being's urethra." Wikipedia promotes a familiar set: merely urinate before intercourse, the logic goes, and you lot'll flush out lingering sperm.
Though the acidity of urine does harm sperm, I could not find whatsoever evidence to bear witness that this strategy is solid. In fact, researchers in the 2011 Human Fertility paper wrote that the volunteers giving samples had, of grade, gone to the bathroom several times since their last ejaculation. Therefore, every time the authors observed sperm in preejaculate, the contagion "must take taken place immediately prior to ejaculation." Conspicuously, there are consequences to misunderstanding this facet of male fertility.
"Fertility Is a Team Sport"
Considering we know so petty about sperm in preejaculate, the failure rate of pulling out is really more of an "educated guess" and a topic of controversy among experts in the field. The reality is that lots of people in the U.Due south. use this method to avoid pregnancy. So, practise males approach withdrawal as a serious form of contraception and take responsibility for learning how to maximize its efficacy? While plenty of men feel confident discussing the minutia of ballgame and female reproductive parts they tend to be quite ignorant of their own fertility.
Greg Sommer discovered but how few males sympathize their contribution to pregnancy when he launched an at-dwelling sperm-testing kit called Trak. In 2017, he brought his product to the Consumer Electronics Show in Las Vegas. "We had a demo kit at our booth, and I tin can't tell y'all how many guys came up and said, 'So, what, I pee in the cup?'"Sommer recalls. "And nosotros had to tell them, 'No, there's no sperm in your urine.'"
Sperm awareness got a heave in 2017, when a meta-assay showed that sperm counts of men from the U.S., Europe, Australia and New Zealand had dropped by more than fifty percent in less than 40 years. "Men are responsible for nearly half of infertility cases merely take way besides long to get a semen analysis when they are non conceiving naturally," Sommer says. The study was widely framed equally a potential crunch in male person fertility, sparking some men to consider their sperm functionality more deeply—or just consider it at all.
Whereas women take long shouldered the burden of both preventing pregnancy (with drugs) and causing pregnancy (with assisted-reproduction technologies such as egg freezing), "there is a growing understanding that fertility is a squad sport," Eisenberg says. "Nosotros need to understand more well-nigh the male side."
Recent population surveys have shown that many men exercise want more birth-control options. Without contraception methods beyond condoms, vasectomy and withdrawal, some guys are already doing "all sorts of crazy and potentially dangerous things to make themselves less fertile to avoid pregnancy," Sommer says.
In discussion forums on Trak'southward infertility didactics Web site at www.dontcookyourballs.com Sommer found that some men "are biohacking themselves" past using prescription steroid creams to intentionally squash sperm count. Others sit down in a hot tub every day. One guy wrote about his "hacked-upwardly underwear heater-type device with a little battery pack," Sommer says. "Don't underestimate men'due south drive and creativity when it comes to having a amend sex life"—significant men will indeed make efforts and take risks to accept sex without condoms.
The Heart for Male Contraceptive Research & Development even exploits this incentive to solicit volunteers for clinical drug trials. One image on the eye's Instagram account features a boxer with a punching bag. "Done with condoms? Bring together the fight for male birth control," it reads, followed past the hashtag #LoveWithoutTheGlove. It seems to exist working: A major clinical trial for a hormonal gel began belatedly last year.
It sounds woefully concerning that scientists and entrepreneurs are convincing guys to learn about reproductive responsibility by appealing to their sexual pleasance—peculiarly at a time when some U.S. lawmakers want to investigate the "misdeed" of miscarriages and classify treatment for ectopic pregnancy every bit an "ballgame."
Yet more options and cognition for preventing pregnancy are good things for everyone. After all, nearly half of all pregnancies in the U.S. are unintended, and the lack of access to birth control and wellness care providers is not the only problem. Nearly twoscore pct of women are not satisfied with the birth-control method they are currently using, co-ordinate to the Guttmacher Institute. When people dislike their contraception for whatsoever reason—including health side effects from the pill or the tactile compromises of condoms—they are less likely to use information technology correctly and consistently.
One twenty-four hour period, if the pharmaceutical industry decides to contrary class and fund the development of innovative birth command, we could go genetic tests and other technologies to help people of both sexes figure out what kind of contraception might work all-time for our individual physiologies and ways of life. In addition to hormones and IUDs, researchers could investigate "proteins, enzymes and genes involved in the reproductive process that could exist targeted to prevent pregnancy in both women and men—and potentially exercise so in more precise means," wrote journalist Maya Dusenbery in the May result of Scientific American.
With a personalized-medicine approach, imagine if nascence control could be catered to the specific needs and priorities of an private. In some cases, the task of preventing pregnancy could be truly shared between a couple. "What if the male person partner is willing to have on some of the risks and side effects to lower the risks and side furnishings of his female partner?" Amory says. "No one has really talked virtually the idea of reframing chance paradigms."
Until this equitable future arrives, understanding the fertilizing potential of an individual's preejaculate could give some men another way to participate in the responsibility of contraception. Allow'southward say that males do autumn into 2 groups, as the Man Fertility study speculates. What if a man—my beau, for instance—could undergo a preejaculate sperm evaluation?
If so, my boyfriend and I might scientifically resolve the final variable in our birth-control efficacy. We utilise coitus interruptus1 during my fertile window, the weeklong bridge during which his sperm can potentially fertilize my egg. (An egg is only viable for fertilization for up to 24 hours per menstrual cycle, and sperm can survive in the female person body for up to 5 days.) I determine this window using a technique called the symptothermal method, a ways of avoiding pregnancy that involves meticulously tracking changes in cervical fluid and basal-body temperature in gild to predict, and then confirm, when ovulation occurs.2
Nosotros devised this contraception strategy based on our personal take chances-benefit analysis and combined physiologies—and it has worked for united states so far. But I'd prefer to empirically validate the absence (or problematic presence) of sperm in my young man's preejaculate. Frustrated by the paltry enquiry, I decided to conduct an experiment myself.
For Science!
The Trak test, while approved by the Food and Drug Assistants, is not designed for testing preejaculate. Nor is it intended to be used as form of pregnancy prevention. Simply according to Sommer, information technology is sensitive enough to option up on sperm concentration as low as ane million per milliliter (1000/mL). While that sounds like a lot, "the chance of pregnancy is extremely low," Amory says. "In fertility settings, we take care of a lot of men with those counts who never conceive spontaneously." The Globe Wellness Organization has determined that suppressing sperm counts to this threshold appears to decrease the chances of formulation to less than i per centum per year.
I ordered a Trak fertility kit and recruited one study participant: later on assuring my young man that his genetic cloth wouldn't exist sent off to a lab and cease upwardly in a database (Trak isn't connected to the Internet), he gave me his informed consent.
First, we did a control test to get a sense of his sperm baseline. Later on 48 hours of abstinence (the minimum length of time for proper semen assay, according to the WHO), he proffered a five-milliliter ejaculation sample. Per the instructions, nosotros let it sit for 30 minutes to liquefy, gave it a proficient swirl, then deposited a pipette's worth of fluid into a test prop. That went into the Trak "engine," an adorably sized, battery-powered centrifuge.
My fellow stared down the engine until it beeped to signal its finish, recalling the way women glare at pregnancy tests while pending the results. A white cavalcade in the prop reached above the 55 Chiliad/mL mark, signaling that his sperm concentration made it into the "optimal" range for formulation. After another 48 hours of abstaining from ejaculation ("for consistent science," I insisted), it was time to exam his preejaculate.
"I think accurately testing just precum might exist a challenge," Sommer wrote when I informed him of my plans to use his exam for off-label endeavors. "Collecting a sample via masturbation might take unlike discharge dynamics than during intercourse."
The hallowed pages of Scientific American are non the place to draw how nosotros collected a full milliliter of unadulterated preejaculate. I will say that our methodology was informed by the science of arousal, a commitment to rigorous inquiry standards and an abundance of humor.
Per the discussions of methodology in the academic studies, we knew it was critical to collect only preejaculate. The authors of the Thai paper wrote that written report volunteers might have smeared semen on the drove slides instead of preejaculate, which could hateful the number of preejaculate samples that were found to contain sperm was artificially high. In other words, the subjects might have been sloppy, leading to simulated positives.
(Anecdotally, highly-seasoned to male person pride created a strong motivation for my volunteer to endure the xxx-ish minutes it took to recollect enough volume of pure preejaculate to run the Trak examination. "Wow, wait at how much you're producing," I cheered near halfway through. By comparison, the bookish study subjects were likely masturbating, presumably alone, in a lab, and I humbly hypothesize that they may have gotten bored. The authors of the 2011 Man Fertility study even suggested that subjects might have knowingly handed over samples of ejaculate fluid because they were embarrassed they couldn't produce sufficient preejaculate.)
Nosotros ran the preejaculate test just as with my beau's ejaculate: a full pipette of well-mixed fluid went into the prop, followed by a half dozen-minute spin in the centrifuge. Then we peered into the measuring strip under bright light and couldn't find even a speck of white. If in that location was sperm present, the concentration was likely below one 1000000 per milliliter, which ways my boyfriend'due south preejaculate sample could be considered infertile by WHO standards.
Though promising, 1 at-home test doesn't confirm anything. We would need to replicate this experiment several more times. Sperm count in semen changes over time and is affected past health factors, and so perhaps the same is truthful for preejaculate. Considering Trak is not intended for such diagnostics, it would be best to compare the results of our experiments with lab tests at a fertility clinic (if they'd even indulge such a request).
Larger questions abound: Even if in that location are sperm in preejaculate, tin they swim? Are all of their parts intact? And if the sperm present in preejaculate aren't simply "left over" from the last ejaculation, then from where might they be "leaking," as the literature suggests?
Filling these noesis gaps has the potential to fine-tune the math of pregnancy risk. Imagine if males were able to improve gauge whether the pullout method is a useful tool in their contraception arsenal or, more critically, whether information technology is too risky even when the act itself is performed correctly every fourth dimension.
After all, contraceptive utilize in the real world is more varied and circumstantial than the behavioral patterns that determine "failure rates." Few people use simply ane method in the same exact way every time they have sex. Contempo surveys suggest that coitus interruptus is actually employed more frequently than previous research suggests and often in conjunction with other methods. If some men do consistently take feasible sperm in their preejaculate, it might help explain the 4 percent failure rate of the withdrawal method despite "perfect" apply. It would not be the commencement time the medical field was incorrect to blame contraceptive failure on user error instead of physiological variation.
At the to the lowest degree, researching the mechanisms of preejaculate and pregnancy chance could add evidence-based nuance to sex teaching. As Amory told me later on reviewing the studies on preejaculate, "I recollect this is an example of when you lot drill down on a 'truth,' one finds it'south non based on much."
1. We could use condoms during my "fertile window," but their failure rate over time is not significantly lower than coitus interruptus . Given the best available science and our personal considerations, nosotros chose to exist in control over preventing user error rather than risk the uncertainty of product failure.
ii. The symptothermal method should not be confused with the rhythm method or similar counting techniques. With perfect utilise, information technology can exist but equally constructive as the pill at preventing pregnancy. While I nautical chart my information in a cycle-tracking app, I do non consult predictive algorithms to determine when I am fertile. Similar all contraceptive methods, the symptothermal method is certainly not right for everyone. It can, all the same, be used as an fantabulous educational tool for learning about fertility and reproductive health.
Source: https://www.scientificamerican.com/article/can-you-prevent-pregnancy-with-the-pullout-method/
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