After many years of “I swear it works,” Duke researches have discovered a truth that might be shocking to some: pulling-out is not the move for preventing pregnancy.
Lead author Dr. Annie Dude, a resident in obstetrics and gynecology at the Duke University Medical Center, was inspired by the widely held belief that if a man pulls out of a woman during sex, just before climax, it functions as an effective contraceptive. But in the study, more than 21 percent of women who used this method experienced an unintended pregnancy. For those who used other birth control methods, it was 13.2 percent.
Dude said she hopes the study, published in the September issue of Obstetrics and Gynecology, will inspire Duke students to practice safer sex techniques.
“Duke students who want to have sex and do not want to become pregnant will use contraception that prevents pregnancy," Dude wrote in an email Wednesday, noting that the most effective methods are long-acting and reversible, like IUDs. "These are available, often covered by insurance or for reduced cost, right here on Duke's campus in the gynecology clinic in Duke South.”
The study collected data from females between the ages of 15 and 24, giving the study direct relevance to college students, said Dr. John Vaughn, director of Student Health Services. He said Duke students have access to a student health center, so they should be more informed than people their age who are not in college.
"The flip side of that, though, is that college students are exposed to more binge-drinking and alcohol-related activities than non-college students," he said. "Those things tend to set you up more for unplanned sexual encounters.”
These unplanned encounters often lead to improvised contraception, like pulling out, he said, adding that students need to be more aware of the potential risks of these methods.
Another study by J. Trussell in Contraceptive Technology elucidates why many people may see pulling out as effective as condoms. There is a 22 percent chance of unintended pregnancy using the withdrawal method, according to that study, but using condoms yields an 18 percent chance of unintended pregnancy.
Vaughn noted that because these statistics are relatively close, many young men and women might not consider the risk worth avoiding. This line of thinking, however, is not sound, he said.
Although the common use of both condoms and the withdrawal method flirt with similar levels of risk, it is much easier to perfect condom use than it is to perfect the withdrawal technique, Vaughn said. The latter requires flawless communication between sexual partners, which is certainly impaired when alcohol is involved, while the former requires only that you know how to put the condom on correctly.
He added that even students who do not rely on pulling out could benefit from education on safe-sex techniques. For example, birth control and condoms both prevent pregnancy, but some people do not consider that birth control does not protect against STIs like condoms do.
"So the big message we need to get out to students is: you’re trying to be protected from both [unwanted pregnancy and STIs]," Vaughn said. "So think carefully about which methods you use. You wouldn’t want students to think ‘Oh, I’m on the pill, so I’m totally okay.’”
Vaughn maintains that the education could be further improved to include information about how the effectiveness of certain methods vary, depending on how correctly they are used, and students should understand the function of each contraceptive.
After all, maybe it’s best to just pull out a condom. Or a textbook.