Comment in:

Stud Fam Plann. 1995 Sep-Oct;26(5):305-6.

Withdrawal: a review of the literature and an agenda for research.

A review to evaluate available literature about withdrawal (coitus interruptus) reveals a dearth of research on the current prevalence, acceptability, use-effectiveness, service-delivery issues, and safety of this ancient and widely used temporary contraceptive method. Population and family planning professionals are shown to have neglected withdrawal in favor of modern, female-controlled methods. This neglect is founded largely upon the popular belief that fertile levels of viable sperm are present in pre-ejaculatory fluid, despite data to the contrary. The validity of existing data on the prevalence of withdrawal is questioned because of the methodological bias inherent in most studies. The use-effectiveness of the practice and its relationship to sexually transmitted diseases have not been adequately investigated. A detailed research agenda on numerous topics concerning withdrawal is proposed.

PIP: The existing literature about withdrawal (coitus interruptus) is reviewed and the paucity of research on the current prevalence, acceptability, use effectiveness, service delivery issues, and safety of this widely used temporary contraceptive method is revealed. In 1991 an estimated 38 million couples relied on withdrawal to prevent pregnancy. This compares to 85 million using the IUD, 65 million using the pill, 30-35 million relying on the rhythm method, 8 million using injectables, and 0.5 million using Norplant. Withdrawal accounted for 9% of overall contraceptive use in developing countries, according to 1986 prevalence surveys. The rates of use were high in Europe also: 22% in Spain, 36% in Italy, 60% in Bulgaria, and 36% in the former Yugoslavia. The validity of withdrawal prevalence data was questioned because of marked underestimates of use. Many women do not regard withdrawal as a contraceptive method, as data from the 1990-91 Pakistan Demographic and Health Survey showed. Another reason for inaccurate data is that many women use more than one method and mix pill use with periodic abstinence or withdrawal. Particularly in Turkey, withdrawal remains the primary contraceptive method, accounting for 42% of all method use. The threat of sudden marriage and financial responsibility for offspring may be a key incentive for use of withdrawal among single adolescent males. The decline in male economic responsibility for children may affect the use of withdrawal, making its use more likely in the nuclear family where a father is financially responsible. Religious views also play a role in Muslim countries, including Turkey. The age factor is important with the highest prevalence occurring among adolescents and older women. 60% of British women discontinued use because of lack of confidence in its reliability. Acceptability is also influenced by the inconvenience and reduced sexual satisfaction of this method as well as the psychological consequences. Use effectiveness has been influenced by long term use which is more effective than first year use. The claims that withdrawal causes prostate disease and psychiatric disorders have not been proven by studies.

PMID: 7570764 [PubMed - indexed for MEDLINE]