Oh baby i'm gonna...
December 17, 2007 2:55 AM Subscribe

BirthControlFilter: My girlfriend believes that in order to be properly safe during sex (in this case baby free) 2 types of preventative measures should be used (condom + pulling out). Any hard facts to back that up? I believe just a condom used properly will be fine.

She believes that it is many times safer to both use a condom and have me pull out before I cum than just having me use a condom. The pill is not out of the question just not availible yet, and if the pill is in use so will a condom, but I am mostly wondering if it really is much safer to pull out when using a condom than not.

posted by anonymous to human relations (33 comments total)

Typical failure rates for condoms are 10% or more - that is, if you use condoms for a year there's a 10% chance you'll end up pregnant. IMO (and it is just an opinion) condoms aren't a great solution for contraception.

Can I suggest you talk to your local equivalent of the Family Planning Association? This is too important to rely on advice from random internet strangers. (An example: taking antibiotics can cause the pill to fail. This is the kind of thing you won't know unless you talk to a professional).
posted by Leon at 3:20 AM on December 17, 2007

The failure rate Leon mentions is for 'typical' use, which includes breakage, putting it on wrong and getting pre-ejaculate (which contains sperm) on the outside of the condom, but most importantly includes "Oops, we've run out. Well I'm sure it will be safe just this time..."

So if you eliminate the 'just this time' condom skippage, you'll go a long way towards cutting that failure rate to the 2-3% failure rate for perfect compliance.

If that failure rate is unacceptable to your girlfriend, then pulling out before ejaculating will reduce it farther. If the condom is defective and has tiny holes that you don't know about, or if it breaks during sex, then pulling out will help reduce the chances of an accidental pregnancy. I don't think this reduces it to 'many times safer', just a little bit safer.
posted by happyturtle at 3:34 AM on December 17, 2007

She's right that you should combine two forms of birth control; this reduces her risk of pregnancy tremendously. So congrats to both of you for A) knowing about that, and B) being responsible enough to do it.

That said, withdrawal before ejaculation is not a form of birth control. It doesn't work, and it won't significantly change the risk involved with condoms.

Rather, she should be on the pill, or use a diaphragm + spermicide. If you combine two viable methods, the chance of pregnancy becomes exceedingly low.
posted by Malor at 3:38 AM on December 17, 2007 [2 favorites]

Actually, condom failure rates are much lower if they're used perfectly which means every time, withdraw properly, etc. The 10-12% failure rate include couples who use condoms as birth control but don't use them every time or don't use them properly. Here's a chart form Planned Parenthood that outlines effectiveness for typical and perfect use of various contraceptive methods.

She believes that it is many times safer to both use a condom and have me pull out before I cum than just having me use a condom.

This doesn't seem to be true based on the chart However, there may be something more going on here than having a statistical back and forth about pregnancy. For some women -- no idea if this is your gf or not -- debates about birth control are sort of an extension of debates about sexual autonomy and control. That is, if she's not comfortable with the "risk" involved with the sex you are having, for whatever reaosn, birth control is a good topic to split hairs over. Just giving her a chart showing her numbers may not mean that she's going to suddenly be won over on the withdrawal argument.

If she's more comfortable with "two methods" you may be able to discuss using contraceptive film which is a great back-up method that still allows you to not have to withdraw. However, be mindful of the fact that this may not at its core simply be a debate about birth control methods, but could be an outcropping of some anxieties about sex and/or pregnancy that need a different sort of discussion to get at.
posted by jessamyn at 3:43 AM on December 17, 2007 [6 favorites]

The spermicides, such as the film or jelly, are most often made out of Nonoxynol-9, which has within the last few years NOT been recommended, because it may increase the risk of STD transmission. Something for everyone to consider.

I'd also like to reiterate that you can lower the failure rate of condoms by making sure you are up to snuff on their correct use. And that you use them all the time. If you have questions about what exactly that entails, feel free to MeMail me. I'm a sex educator and am bound by my job ethics to keep things confidential.

And Jessamyn is entirely correct that this could be a case where she feels like she's not in control from her side when the only form of contraceptive you're using is male controlled.
posted by Stewriffic at 4:31 AM on December 17, 2007 [1 favorite]

The "hard facts" are the fact that no birth control method other than abstinence is perfect, and the laws of probability, which say that the probability of two independent* methods failing simultaneously is the product of the probability of either of them failing. Using jessamyn's Planned Parenthood charts, if a "perfectly used" condom has a 2% failure rate, and "perfectly performed" withdrawal has a 4% failure rate, we see that using both together has a rate of .08% — more than 50 times the effectiveness of either method used on its own. Using the same charts with "typical" figures (15% and 27%), we see the combined failure rate is 4% — still considerably more effective than either method by itself.

* independent in this sense means not based on one another. If Method A and Method B were both "withdrawal", obviously the combined probability would still be 4%, not .16%.
posted by ubiquity at 4:55 AM on December 17, 2007

I'm sure I've had a success rate of more than 99.9% with condoms. The couple of times that one broke were more than 15 years ago. I'm guessing condoms are better now than they were then.
posted by strangeguitars at 4:55 AM on December 17, 2007

strangeguitars's perception is probably based on individual use rather than yearly use. In other places, the 2% failure rate is explained as meaning that "In one year, only two of every 100 couples who use condoms consistently and correctly will experience an unintended pregnancy—two pregnancies arising from an estimated 8,300 acts of sexual intercourse, for a 0.02 percent per-condom pregnancy rate." Actually, this is .024%, or a 99.976% rate of effectiveness per individual sex act. This points out that another way to improve the numbers is to have less sex, but that may not be what you had in mind.
posted by ubiquity at 5:28 AM on December 17, 2007 [1 favorite]

Here are the instructions for perfect use. They are not that difficult, but in the heat of the moment it's easy to perform some of them inexactly. I have to say, looking at the instructions, that I personally may never have performed the instructions with total perfection (a possible connection with why I have three kids?). YMMV, but don't use the 2% figure in your calculations unless you can always guarantee perfection.
posted by ubiquity at 5:34 AM on December 17, 2007

The "hard facts" are the fact that no birth control method other than abstinence is perfect

Ovariohysterectomy. Sufficiently drastic vasectomy.

But yes, ubiquity has this right. Using two methods really will reduce her odds of pregnancy "many times". But she should pick two better methods.
posted by ROU_Xenophobe at 5:37 AM on December 17, 2007

100 couples ... an estimated 8,300 acts of sexual intercourse

Woah -- does the average couple have sex only 83 times a year?

I think Jessamyn is right, that there is more going on than just birth control concerns. I think you will get further addressing the deeper issues than you will arguing about birth control.

Using two methods is probably not a bad idea (although I have remained childless despite virtually never using two methods at once, so using one method alone is not some guarantee of getting preggers), but there are nicer options than withdrawal. (I associate withdrawal more with having unprotected sex and having second thoughts right at the end, rather than as a pre-planned part of a normal birth control regime.)

But I did have one friend who wouldn't let any of her boyfriends come inside her (condoms or no condoms) -- that was, for her, a really intimate and special thing that she intended to reserve for when she found "true love." Could your girlfriend be thinking in that way?
posted by Forktine at 5:47 AM on December 17, 2007

'a "perfectly used" condom has a 2% failure rate, and "perfectly performed" withdrawal'
Both require perfection on the part of the same person, so they're not independent, and although combining will be better it won't be the ideal of 50 times better ubiquity mentions.

Regardless of this, I'm in agreement with everyone else who says if you're going to use a second method pick a better one.
posted by edd at 5:51 AM on December 17, 2007

Uh, when they refer to "perfectly performed withdrawal" in condom use, they aren't talking about pulling out before orgasm. They are talking about not remaining inside your partner until you become flacid so that the condom no longer remains right around the penis, and removing your penis with the condom still firmly attached (the condom doesn't slip off during withdrawal).
posted by grumpy at 6:02 AM on December 17, 2007

Pulling out during sex before ejaculating while keeping the condom fully on as a regular exercise? Withdrawal seems to me like a possibly counter-effective method of birth control to be combined with condoms.
posted by desuetude at 6:11 AM on December 17, 2007 [1 favorite]

What desuetude said was my first thought-- Pulling out mid-coitus, with a condom on? That's asking for slippage...
posted by Adelwolf at 6:30 AM on December 17, 2007

Malor, sorry, but you're not quite right. Pulling out is a form of birth control. It's probably the oldest form, in fact (not that that has anything at all to do with how well it works, just saying). It just has a very low efficacy rate. If someone ever getting pregnant while using any particular form of birth control constituted it not being birth control, well then nothing would qualify as birth control. I certainly agree that it is highly inadvisable to take it very seriously as a way to prevent pregnancy. I don't know specifically about failure rates specifically of condoms and pulling out combined, but you'd still be better off combining condoms with another more effective form, like hormonal birth control and/or spermicidal lubricant (most condoms have some already).
posted by gauchodaspampas at 6:36 AM on December 17, 2007

Also, what jessamyn said. For some women (and men), a <1> <1> chance of getting pregnant, along with the drastic change in lifestyle, and everything else that goes along with that. So it's not so much a cost/benefit thing as a doing everything you possibly can to avoid it thing.
posted by gauchodaspampas at 6:49 AM on December 17, 2007

Bah. Formatting did some funky stuff to my post. That's supposed to be a [small] <1% [/small].
posted by gauchodaspampas at 6:50 AM on December 17, 2007

It sounds like you're asking because you really would rather not pull out. And that's fine, as you can see here there are lots of other ways to cut the risk, so present them to your girlfriend, and be honest about why you'd rather be inside her when it happens-- don't disingenuously approach this as if it's all just about safety or she'll think you're just being obtuse.
posted by hermitosis at 6:54 AM on December 17, 2007

There are worse things than condoms. One of those things is, not having sex. That said, sex that doesn't involve actual penetration can be just as much fun.

Probably the best thing you can do in this situation without looking like an idiot (and believe me, if you tell her she's wrong you stand a very good chance of looking like an idiot), is go together to a doctor or family planning clinic or something similar to discuss birth control generally, and the effectiveness of various methods, including condom + pullout. There and then is a good place to ask the doctor, "what happens if some spills out?"

Do this ASAP preferably before you next have sex, or at least not penetrative sex.
posted by aeschenkarnos at 7:00 AM on December 17, 2007

As other people have mentioned, using two forms of birth control in parallel (two independent forms -- you can't just use two condoms or something) substantially lower your risk.

However, I don't think that pulling out is a good choice, for several reasons: first is that the act of pulling out is very likely to result in the condom slipping off. If that happens, well, just consider the, uh, geometry. You don't need to be in her to get her pregnant. I would argue that using a condom and pulling out are not "independent" methods of birth control. By pulling out, you're messing with how the condom is designed to be used, and that may make it less effective. I have no hard data, but at the very least it throws the numbers into question.

Also, there are other forms of backup BC that you could use that are more effective. And third, it just sucks and IMO ruins sex to have to pull out. I'd frankly prefer to just avoid penetrative sex if I'm going to have to do that (there are a lot of fun non-penetrative things you can do instead). But that's just me; YMMV.

So while her logic is sound I think the execution is flawed. You would both be much better off going with hormonal birth control and condoms (offer to pick up at least half of the cost, by the way, if not all of it -- if the only reason she's on birth control is because of you, it's only fair). Because the pill is so much more effective than withdrawal, the net failure rate from condom+pill is going to be much better than condom+withdrawal. (And condom and pill are actually independent methods; use of one will not adversely affect the use of the other -- so you really can multiply their risks together for a much lower net risk.) That would be the ideal solution in my opinion.

The next option down would be condom plus spermicide, either gel or foam or films. But do beware of the increased STD risk, and go get tested first, both of you.

And beware that this birth control issue may really be masking other issues on her part. She may just not want you to come in her. So if you present what seems to you to be a logical argument and she starts splitting hairs, understand that it may not be the "risk" at all that's driving her position.
posted by Kadin2048 at 7:35 AM on December 17, 2007

According to this random web site, pulling out leads to 27% of couples becoming pregnant over the course of a year. Without any contraception at all, the number is 85%. So clearly, pulling out does something, sort of. Condoms are more effective, and combining the two would, in a statistical sense, increase protection even further. Not sure about the physics of it, however (re: the slippage comments).
posted by knave at 7:48 AM on December 17, 2007

Withdrawal sucks as contraception. Frankly I think that it spoils the fun of it. If you are crazy disciplined it can work. If you offered me condom+withdrawal sex, I'd probably take a walk instead.
posted by a robot made out of meat at 7:56 AM on December 17, 2007

To make it explicit how that's an answer: either you get very frustrated and stop doing it, or get very frustrated and stop doing it. So not very effective if you're into the act.
posted by a robot made out of meat at 7:58 AM on December 17, 2007

Yes, using two forms of birth control at the same time is a good idea and increases your chances of not becoming pregnant, but ... in most equal partnerships, each partner chooses a form of birth control for themselves that they are comfortable with, so the stress of not becoming pregnant isn't all on one person. Right now, you are the only one keeping a pregnancy from happening. She needs to consider doing her part and using a diaphragm, sponge, gel, pill, or whatever.

Also, one of my friends used the condom/pulling out method with his girlfriend, and now we call him Dad. Just a little anecdote, but while doing both is better than doing nothing, it can cause problems. When it goes wrong, it can really go wrong.
posted by Orb at 8:07 AM on December 17, 2007

It usually takes people a year to get pregnant when they are TRYING to have a baby. So combine that fact with the much-quoted 2% failure rate of properly used condoms and you can see that the odds are in your favor. Otherwise, buy a jug full of the morning-after pill or just get a vasectomy. . .
posted by Cochise at 8:47 AM on December 17, 2007

To echo part of Orb's point, regardless of how effective Withdrawing is, if she's going to insist on two methods of birth control, it only seems fair that one of the methods is her responsibility. i.e.: pill, diaphragm, et cetera. Sex requires two people who should split the resposibility of safe sex equally. And if it is a control issue with her, as others have suggested, it would make sense for her to take some control.
posted by srw12 at 9:43 AM on December 17, 2007

Malor, sorry, but you're not quite right. Pulling out is a form of birth control. It's probably the oldest form, in fact (not that that has anything at all to do with how well it works, just saying). It just has a very low efficacy rate.

It's not a good idea to split hairs on this one. Pulling out doesn't work; it is, therefore, not a form of birth control. It's a form of wishful thinking.

This has been said many times, but bears repeating: the word for people who rely on the withrawal method is "parents".
posted by Malor at 9:46 AM on December 17, 2007 [3 favorites]

Malor: See my link.
posted by knave at 9:58 AM on December 17, 2007

At the risk of being too obvious: Use a condom and pull-out after she's gotten hers. Then have her finish you orally, sans condom. Everybody's happy.
posted by LordSludge at 10:09 AM on December 17, 2007

I think I get why folks are so invested in saying that withdrawal is not a form of birth control, in that they don't want to encourage people to use it, but it very clearly IS a form of birth control, just a less effective one than most other forms. It does reduce the odds of getting pregnant (see various links). It sucks, for a whole bunch of reasons, but it is better than doing nothing (and worse than just about anything else one could do for contraception.)

For all that, my money's on jessamyn's answer, that the OP's girlfriend has other concerns about the sex and control, and that the couple in question would benefit from a good conversation about what's going on.
posted by gingerbeer at 11:30 AM on December 17, 2007

[a few comments removed - please do not continue the "withdrawal is/is not a form of birth control" derail in this thread.]
posted by jessamyn at 11:41 AM on December 17, 2007

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