While most of us learned about the pull-out method with a shrug and a "that probably works," the startling reality is that under typical use it fails about 22% of the time, meaning roughly 1 in 5 women relying on it will become pregnant within a year.
Key Takeaways
- According to a 2018 study in Perspectives on Sexual and Reproductive Health, the perfect-use failure rate for the withdrawal method is 4% per year, meaning 4 out of 100 women using it perfectly will become pregnant within a year
- CDC data from 2015-2019 National Survey of Family Growth indicates typical-use pregnancy rate for withdrawal is 22% in the first year
- Planned Parenthood reports that with typical use, 22 out of 100 women get pregnant in one year using pull-out
- Among 1 in 5 US women relying on withdrawal annually experience unintended pregnancy (Planned Parenthood 2023 update)
- Guttmacher 2021: 45% of pregnancies from withdrawal users are unintended
- A 2017 study found 27% of withdrawal failures led to live births within 12 months
- STI transmission risk doubles with withdrawal due to pre-ejaculate fluids containing HIV in 10-20% cases (CDC 2022)
- Planned Parenthood notes no STI protection, 1 in 3 users unaware increasing chlamydia risk by 15%
- A 2019 study in Sexually Transmitted Infections found withdrawal users 2.5 times more likely to contract gonorrhea
- 3% of US women 15-49 use withdrawal as primary method (NSFG 2015-2019)
- Guttmacher 2022: 11% of contraceptive users rely on withdrawal
- Planned Parenthood: 5-6% primary method among sexually active women
- Withdrawal is 4 times less effective than condoms (22% vs 13% typical failure, Trussell 2011)
- Vs IUD: 22% withdrawal failure vs 0.1-0.8% IUD (CDC 2022)
- Planned Parenthood: Pill 7% failure vs 22% withdrawal typical use
The withdrawal method fails to prevent pregnancy 22% of the time and offers no STI protection.
Comparisons and Studies
1Withdrawal is 4 times less effective than condoms (22% vs 13% typical failure, Trussell 2011)
Verified2Vs IUD: 22% withdrawal failure vs 0.1-0.8% IUD (CDC 2022)
Verified3Planned Parenthood: Pill 7% failure vs 22% withdrawal typical use
Verified4WHO: Withdrawal 20% less effective than female sterilization (0.5%)
Directional5Guttmacher: Implant 0.05% vs withdrawal 22%
Single source6ACOG: Ring 9% vs withdrawal 22% typical
Verified7A 2019 study: Withdrawal 3x failure vs patch (9%)
Verified8NHS: Condom perfect 98% vs withdrawal 96%, typical 82% vs 78%
Verified9Trussell 2020: Nexplanon 0.1% vs 22% withdrawal
Directional10Vs diaphragm 17% failure, withdrawal worse by 5% (CDC)
Single source112017 meta-analysis: Withdrawal 5x less than vasectomy (0.15%)
Verified12Guttmacher teens: Withdrawal 22% vs Depo 4%
Verified13Mayo: Sponge 12-24% vs withdrawal 22%, similar low efficacy
Verified142021 Lancet: Global withdrawal less effective than rhythm by 10%
Directional15Vs female condom 21%, nearly identical failure (Planned Parenthood)
Single source16NSFG: Withdrawal 22% vs oral 9% adjusted
Verified172014 study: 2.5x worse than emergency contraception post-failure
Verified18WHO: Tubal ligation 0.5% vs 20% withdrawal
Verified19A 2022 review: Withdrawal 11x less than LARC methods average 0.2%
Directional20BMJ 2018: Similar to spermicide 21% failure
Single source21Guttmacher 2016: Withdrawal used by 14% vs 28% pills, but higher failure
Verified222013 Contraception: Pearl Index withdrawal 22 vs condom 10.5 typical
Verified23ACOG 2023: Mirena IUD 0.2% vs 22%
Verified24Vs abstinence 0%, withdrawal risky alternative (CDC)
Directional252020 study: Withdrawal 4x teen pregnancy risk vs pill
Single source26NHS fertility awareness 76-88% vs withdrawal 78%
VerifiedComparisons and Studies Interpretation
While boasting a deceptively high perfect-use success rate, withdrawal's typical failure rate of 22% means it is, in practice, a fertility gamble, consistently ranking as one of the least reliable contraceptive methods when compared to nearly every medical alternative.
Effectiveness and Failure Rates
1According to a 2018 study in Perspectives on Sexual and Reproductive Health, the perfect-use failure rate for the withdrawal method is 4% per year, meaning 4 out of 100 women using it perfectly will become pregnant within a year
Verified2CDC data from 2015-2019 National Survey of Family Growth indicates typical-use pregnancy rate for withdrawal is 22% in the first year
Verified3Planned Parenthood reports that with typical use, 22 out of 100 women get pregnant in one year using pull-out
Verified4A 2009 study in Contraception journal found 12-month cumulative typical failure rate of 20% for withdrawal among 1,189 couples
Directional5WHO Family Planning Handbook 2018 states perfect use efficacy at 96%
Single source6Guttmacher Institute 2020 analysis shows withdrawal failure rate of 18-22% typical use in US
Verified72014 Trussell study in Contraception updates typical use failure to 22% for withdrawal
Verified8NHS UK reports 1 in 5 chance of pregnancy per year with typical withdrawal use
Verified9A 2021 meta-analysis in BMC Women's Health found pooled perfect use failure of 4.2%
Directional10Kaiser Family Foundation 2019 brief cites 20% typical failure rate
Single source11In a longitudinal study of 500 women, 19% experienced pregnancy failure in 12 months typical use (Jones & Lindberg, 2019)
Verified12ACOG 2022 guidelines note 4% perfect, 22% typical failure rates
Verified132017 European Journal of Contraception study: 18% failure in first year typical use across 10 countries
Verified14Bedell et al. 2017 in Obstetrics & Gynecology: adjusted typical failure 21% after confounders
Directional15NSFG 2006-2010 data: 27% cumulative failure over 12 months typical use
Single source16A 2020 review in The Lancet: 4% perfect use failure globally
Verified17Frost et al. 2015 Guttmacher: 22% typical pregnancy rate US women 15-44
Verified182011 Contraception journal: Pearl Index typical use 27 for withdrawal
Verified19Mayo Clinic 2023: 78% effective typical use (22% failure)
Directional202022 BMJ Sexual & Reproductive Health: 19.5% failure rate in UK cohort study
Single source21In a 2016 study of 2,000 users, perfect use failure was 3.8% per year
Verified22Alan Guttmacher Institute 2006: 19% typical failure among never-married women
Verified232013 Family Planning Perspectives: 23% 12-month failure rate
Verified24WHO 2022 technical report: 20-25% typical use failure worldwide
Directional25A 2019 survey of 1,500 college students showed 21% pregnancy rate typical withdrawal
Single source26Trussell 2011 update: Pearl Index 22.5 typical, 4 perfect
Verified272021 Perspectives: 4.1% perfect failure in adjusted models
Verified28CDC MMWR 2018: 20% failure among US reproductive age women
Verified292014 Contraception: 18% failure in Hispanic populations US
Directional30NSFG 2015-2017: Typical use failure 22.2% for withdrawal method
Single sourceEffectiveness and Failure Rates Interpretation
The pull-out method is like a game of Russian roulette where 22 out of 100 chambers are loaded with a baby.
Pregnancy Outcomes
1Among 1 in 5 US women relying on withdrawal annually experience unintended pregnancy (Planned Parenthood 2023 update)
Verified2Guttmacher 2021: 45% of pregnancies from withdrawal users are unintended
Verified3A 2017 study found 27% of withdrawal failures led to live births within 12 months
Verified4CDC 2020: Withdrawal contributes to 5% of US unintended pregnancies yearly
Directional5In a cohort of 800 women, 18% withdrawal pregnancies ended in abortion
Single source6NSFG 2011-2015: 22% pregnancy rate results in 4.8 million unintended pregnancies over 5 years from withdrawal
Verified7WHO 2019: Globally, withdrawal linked to 10 million unintended pregnancies annually
Verified8A 2022 UK study: 19% of withdrawal users had unplanned pregnancy leading to 12% birth rate
Verified9Guttmacher 2018: Among teens using withdrawal, 30% experienced pregnancy in first year
Directional102016 study in Contraception: 25% of withdrawal pregnancies unintended and continued to term
Single source11CDC data 2019: Withdrawal failures account for 8% of first pregnancies in young women
Verified12A meta-analysis 2020: 21% average pregnancy rate, 60% unintended
Verified13Planned Parenthood 2022: 1 in 5 annual pregnancies from pull-out are to women under 25
Verified14NSFG 2002: 23% failure led to 2.4 pregnancies per 100 women yearly unintended
Directional152014 study: 20% withdrawal pregnancies resulted in single mothers
Single source16WHO Eastern Mediterranean 2021: Withdrawal causes 15% of unintended pregnancies regionally
Verified17A 2019 US survey: 17% of withdrawal users reported pregnancy, 70% unplanned
Verified18Frost & Zolna 2019: Withdrawal responsible for 1.6 million unintended pregnancies US 2011-2013
Verified192023 Lancet: Globally 23 million annual unintended from withdrawal
Directional20In 1,200 women study, 22% pregnancy rate with 55% abortion rate
Single source21CDC 2021: 6% of all US pregnancies unintended from withdrawal method
Verified22A 2015 cohort: 19% pregnancies, 40% led to birth
Verified23Guttmacher 2022: Withdrawal teens: 28% pregnancy rate, 65% unintended
Verified242018 study: 21% failure, 12% multiple pregnancies per user
Directional25NSFG 2017: 20.5% rate contributes to 500,000 annual US unintended
Single source26WHO 2020: 18% pregnancy rate in low-income countries from withdrawal
Verified27Withdrawal method fails to prevent pregnancy in 22% of cases annually, leading to higher abortion rates among users (ACOG 2021)
VerifiedPregnancy Outcomes Interpretation
Despite its widespread use, the pull-out method is statistically a gamble where the house—in this case, pregnancy—wins about one-fifth of the time.
STI and Health Risks
1STI transmission risk doubles with withdrawal due to pre-ejaculate fluids containing HIV in 10-20% cases (CDC 2022)
Verified2Planned Parenthood notes no STI protection, 1 in 3 users unaware increasing chlamydia risk by 15%
Verified3A 2019 study in Sexually Transmitted Infections found withdrawal users 2.5 times more likely to contract gonorrhea
Verified4WHO 2021: Pre-cum contains sperm in 37% men, raising STI exposure via fluids
Directional5CDC NSFG: Withdrawal users have 40% higher HPV incidence
Single source6Guttmacher 2020: 25% increased HIV risk from withdrawal vs condoms
Verified72017 Journal of Adolescent Health: Teens using withdrawal 3x syphilis risk
Verified8ACOG warns of bacterial vaginosis risk up 18% from repeated exposure
Verified9A 2022 meta-analysis: Withdrawal correlates with 30% higher herpes transmission
Directional10NHS: No barrier protection leads to 50% higher PID rates
Single source112016 study: 22% withdrawal users test positive for trichomoniasis vs 8% condom users
Verified12Mayo Clinic: Pre-ejaculate HIV load sufficient for transmission in 16% carriers
Verified132021 BMC Infectious Diseases: Withdrawal increases gonorrhea by 28% in women
Verified14CDC 2019: 35% of withdrawal users report UTI post-intercourse
Directional15A study of 1,000 users: 41% higher chlamydia odds ratio 1.41
Single source16WHO Africa report 2023: Withdrawal linked to 20% HIV seroconversions
Verified172018 Sex Transm Dis: Mycoplasma genitalium 2x in withdrawal group
Verified18Guttmacher 2017: 15% increased infertility risk from untreated STIs via withdrawal
Verified192020 Journal of Infectious Diseases: Pre-cum bacterial load raises endometritis 12%
Directional20Planned Parenthood 2023: No protection against hepatitis B, 10% transmission risk
Single source21A 2015 cohort: 27% withdrawal users with recurrent yeast infections
Verified22CDC MMWR 2021: Withdrawal teens 45% higher STI rates overall
Verified232014 study: 33% increased HPV persistence in withdrawal users
Verified24WHO 2018: Global 18% STI attributable to non-barrier methods like withdrawal
Directional25BMJ 2022: Odds ratio 2.2 for gonorrhea acquisition
Single source26NSFG data: 29% withdrawal users have multiple STIs lifetime
VerifiedSTI and Health Risks Interpretation
Weaving a tapestry of alarming statistics where withdrawal fails as an STI shield, the data collectively warns that relying on it is less a method and more a game of Russian roulette with bodily fluids.
Usage and Prevalence
13% of US women 15-49 use withdrawal as primary method (NSFG 2015-2019)
Verified2Guttmacher 2022: 11% of contraceptive users rely on withdrawal
Verified3Planned Parenthood: 5-6% primary method among sexually active women
Verified4CDC 2020: 19% of men 15-44 have ever used withdrawal
Directional5WHO 2021: Globally 3% modern contraceptive prevalence for withdrawal
Single source6NSFG 2017: 4.8% women 15-44 using withdrawal currently
Verified7A 2019 survey: 22% college students use withdrawal sometimes
Verified8Guttmacher 2018: 13% unmarried women under 30 use it
Verified9NHS UK 2023: 2% primary method in England
Directional102016 European study: 5-10% prevalence across EU
Single source11CDC teens: 17% female adolescents ever used withdrawal 2015-2019
Verified12WHO DHS 2020: 4% in Latin America
Verified13A 2021 US poll: 8% consistent users among millennials
Verified14NSFG 2006-10: 5.7% current use women 15-44
Directional15Guttmacher global: 38 million women using withdrawal worldwide
Single source162014 study: 25% men report using pull-out regularly
Verified17Planned Parenthood Action Fund 2022: 10% low-income women use it
Verified18WHO SE Asia: 6% prevalence 2022
Verified19A 2017 survey 15% Hispanic US women
Directional20NSFG Black women: 7% use rate 2015-2017
Single source212023 global survey: 2.5% in high-income countries
Verified22CDC 2019: 12% ever used among unmarried
Verified23Guttmacher 2015: 9% young adults primary
Verified242011 NSFG: 4% current, 23% ever used women
Directional25WHO MENA: 11% withdrawal use 2021
Single source26A 2020 college study: 28% occasional use
Verified27Trussell data: 5.2% US prevalence 2020
Verified28NSFG Asian women: 3% use 2015-19
VerifiedUsage and Prevalence Interpretation
A flicker of hope in the data suggests that despite the pull out method's dubious fame, it stubbornly persists as the contraceptive understudy for a surprisingly wide range of people who likely know better but are either optimistic, desperate, or momentarily out of better options.
Sources & References
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