The doctor asked me to put my socked feet into the stirrups and slid a speculum inside me, followed by her fingers. She pressed down on my belly and watched me wince under her touch. My abdomen, as it so often is, was tender.
"That hurt?" she asked. I bit my lip and nodded.
Later on, after I was dressed, she handed me a pamphlet about Mirena, a hormonal IUD, and placed a prototype in my palm. It was tinier than I thought, just a couple of inches long and T-shaped. It felt like I could easily snap it in two with my fingers. I handed it back to her, shook my head and told her I wasn't interested. Instead, I inquired about tubal ligation or a possible partial hysterectomy as a way to deal with the intensely painful periods that had been plaguing me since I was 10 and a permanent solution to never having to worry again about accidentally making a baby.
She told me I was too young to make such an irreversible decision about my fertility. I am 37. I've known for nearly a decade that I don't want biological children. I told her I wouldn't be changing my mind about that. Regardless, she dismissed my request as premature. I responded that I didn't want an IUD, not now or ever.
In fact, I refuse to use any kind of hormonal birth control or inserted device.
I've tried many types of birth control pills in the past in an attempt to regulate my cycles and ease my killer cramps, years before I even lost my virginity. Everything from Ortho Tri-Cyclen to progestin-only pills to low-dose hormone brands like Loestrin. Not only did every type I tried fail to bring me any relief from my menstrual pain—pain that I would find out in my early twenties was due to a severe case of endometriosis—but taking the pills brought a whole new slew of side effects to deal with. On one brand I gained 20 pounds, broke out in bad rashes, experienced dramatic mood swings, and couldn't sleep. On another, my breasts engorged with golf-ball-sized cysts that endured month-round and only shrunk when I stopped taking it. My final attempt, on the low dose pills, caused my calf to swell with what I was told was the threat of thrombosis—a potentially fatal condition that can cause blood clots in the legs. I was done. At 24, I quit birth control pills for good and swore to find a way to manage both my endometriosis and my desire to never get pregnant in a way that didn't cause more suffering for myself.
Sure, it’s possible that, with a few more rounds of contraception roulette, I would have found the perfect hormonal solution—and many women do, with the help of a savvy and caring physician—but I'd put myself through enough hell. It was then that I began to consider what has long been an unfairly maligned option: the withdrawal, or “pull-out,” method.
A few months later, I met the man I would be with for the next nine years. The first few months of our courtship we used condoms. But having sex with them on a daily basis began to irritate my insides to the point where my groin burned and itched for hours afterward. While not technically allergic, I definitely seemed to be sensitive to latex, especially when exposed to it in such an intimate area for too long or too many times in a row. My boyfriend had only had one partner before me, and they had been each other's firsts; I’d only had two partners before him and had since been tested twice for STIs and HIV and was given a clean bill of health.
So we knew that, if we were to ditch our protective gear, disease was not a real risk—just pregnancy. That’s when we began to use the pull-out method instead, relying on condoms only during "dangerous" times of the month mid-cycle when I was likely to be ovulating.
For me, the signs for when I’m ovulating have always been really clear (I get extremely wet and have telltale pain in a specific part of my abdomen that marks the release of an egg), so I didn't need to do much guesswork to decipher those dates. Nonetheless, I also used a small calendar and even bought a tiny telescope onto which I would smear my saliva every morning upon waking. If the dried saliva forms fern leaf designs, I am fertile. Likewise, the farther back my cervix moves, the more at risk I am for pregnancy—so I got used to fingering myself most mornings to check its location. (I learned these techniques thanks to extensive research about fertility.) This made me more acquainted, and therefore much more comfortable, with my body, which made for a hotter sex life. So did the pull-out method, as it became incorporated into our sex play—where he would ejaculate onto me, which added to our intimacy.
Withdrawal has had a bad rap for decades now, even though it's probably the oldest form of birth control. It's been mocked by Roxane Gay, who in her Bad Feminist essay “The Alienable Rights of Women” wrote, “Pulling out is only believable in high school.” It’s also been the butt of jokes, often referred to as a birth control myth on par with jumping up and down after sex or douching with Coca-Cola. After a woman writing for XO Jane confessed she unapologetically used it for birth control, she was bombarded with hundreds of comments disparaging her for her decision and calling her things like “a moron” and “dumb.”
When not practiced responsibly, the pull-out method can be risky, yes. And it’s not right for everyone. Mature men tend to have more control over the timing of their ejaculations than teenage boys, for example, while teenage girls tend to have irregular cycles, making it more difficult to accurately track and predict fertile times of the month. But for me, the method has been a godsend—and in recent years, science has begun to back up my experience.
According to Planned Parenthood, the withdrawal method is 96% effective when used correctly every time—compared to 98% for male condoms. And while this falls short of the 99.9% effectiveness rate of IUDs, including Mirena, it is far superior to, say, the cervical cap (86%). It even beats out both a diaphragm with spermicide (94%) and female condoms (95%) in preventing pregnancy, while also not putting the people using it at risk for the urinary tract infections, yeast infections, or Toxic Shock Syndrome that insertion methods can sometimes contribute to or cause. Of course, these all assume perfect use of the method, which is why it is really important when using withdrawal to get it right every time; otherwise, its effectiveness can drop dramatically, to as low as 73%.
One of the central arguments against using the pull-out method is that pre-ejaculate can contain sperm. But how big a threat is this? While some studies have found no sperm in men's pre-cum, a 2010 study of 27 men found that 10 of the participants' pre-cum indeed contained some living sperm, but the amount was so low that it posed a very low-risk of pregnancy. Not only that, the same study suggested that it may always be the same men who have sperm in their pre-cum, while those who don’t consistently do not. Most experts also agree that some living sperm can remain in the urethra after intercourse and impregnate someone in a subsequent encounter, but this scenario can be easily prevented by making sure the man urinates between sex sessions (as well as washes up on the outside).
And yet, despite the evidence suggesting withdrawal can be just as effective as other popular forms of contraception when used every time, it is still the target of backlash and scorn.
When Rachel K. Jones, a senior researcher with the Guttmacher Institute, published a report supporting its validity as a birth control method back in 2008, she was lambasted in the media. But my personal experience assures me Jones is right that withdrawal can be a valid form of contraception. And as someone who is not a teenager, I believe I and other women like me in similarly monogamous relationships deserve to be educated about our options, especially when we have a history of adverse reactions to hormonal birth control methods.
For the first few years we were together, my partner and I used withdrawal in at least seven or eight out of every 10 times we had sex, till we eventually stopped using condoms altogether. We had sex at least a thousand times using withdrawal. I had never once become pregnant or had a serious pregnancy scare. Likewise, over the years, I’ve made friends with many other women in long-term, monogamous relationships who have confided in me that they use this method much or most of the time with great success. They always tell me this in confidence because they are afraid of being mocked or scolded as stupid.
On the other hand, I've had condoms slip off inside me, forcing me to run to a clinic at dawn to take Plan B and endure the side effects. And I've had more than one friend who became pregnant while on the pill.
Many of my friends on hormonal birth control have also admitted to a lessening or loss of libido and lubrication while on them, which has prompted me to often wonder what the point of having great birth control is if we can't enjoy or aren't into the sex? I want to enjoy the sex I’m having or not have it at all. It's not just for my partner—it’s for both of us.
One of the things I love about withdrawal is that it shifts some of the contraceptive responsibility, which is so often entirely the burden of the woman, to the man, while not dampening the man's sensations or killing the woman's capacity for lust. If anything, I feel like using the pull-out method makes me more bonded to my boyfriends, because it relies on deep trust and affection. Before we embark on using it, we both get tested and share our results with each other. It is an intimate thing to have someone inside me without a condom and requires my partner and I to stay in tune with we each other’s bodies and rhythms, contributing to more intense orgasms. Afterward, we check in with each other. Additionally, since withdrawal doesn’t offer us the false sense of security other contraceptive methods often do, it has forced us to have frank conversations about what we would do if we had an accident. This means all our cards are on the table.
The withdrawal method is free, while an IUD can cost upward of $700, depending on one's insurance. It's easy and accessible, and it doesn’t have any harmful hormonal impact on my body, risk puncturing my uterus (which, while rare, can happen with IUDs), or cause immense irritation to my hypersensitive skin.
No method is perfect. I've even known more than one person who has gotten pregnant after their partner underwent “permanent” sterilization via a vasectomy. And I am sure there are women who have used withdrawal responsibly and gotten pregnant. I don't deny their experiences, just as I don't want the credibility of my experience denied or dismissed by those who haven’t opened their minds to the method.
While it may not be for everyone, especially hair-trigger teenagers or college kids who haven’t mastered control of their ejaculations, or for casual encounters (since it does not prevent STIs), I believe withdrawal can be a viable option for monogamous couples in trusting relationships for whom other alternatives have failed. At least in my particular case, the extent of my endometriosis deems me likely less fertile to begin with than the average woman, and at 37, I am even less so than I was 13 years ago when my ex and I first started using withdrawal as our method of choice.
I now use withdrawal as my sole method of contraception with my current partner and will continue to use it until a doctor agrees to give me the surgical procedure I want so I can be even more carefree in my sex life than I already am. Ultimately, is it up to us to choose the methods that work best with our bodies and deal with the fallouts or failures if and when they happen, like grown-ups do.
In the meantime, it’s time for the pull-out method to be accepted into open discourse about the contraceptive options available to mature, sexually active, cisgender women. It's time we stop shaming or stigmatizing women for our choices about our own bodies. And it’s time we stop depriving ourselves of real statistics and science that enable us to make those choices in an informed way—one that is healthiest for us and our relationships.
Laura Kiesel is a Boston-based writer whose articles and essays have appeared in The Atlantic, The Guardian, Salon, Al-Jazeera America, Dame, Narratively and many others. She is currently completing a collection of linked personal essays.