Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Ask About Withdrawal (Really!)
September 2014


Almost one in three young women ages 15 to 24 years old report having relied on withdrawal in the previous three years.[1] In fact, almost 60% of reproductive-age women report having relied on withdrawal at some point in their lives.[2] Yes, that withdrawal…coitus interruptus, the ancient method of birth control most clinicians thought went the way of homing pigeons and schooners. Not so. Withdrawal is alive in well, in the United States.

Often, women may not acknowledge use of withdrawal because it may be supplemental to another method. A woman may forget to have taken oral contraceptives, or run out of pills, and so fall back to withdrawal as a backup method. If she relies on fertility awareness methods, she may think about using withdrawal during those days designated for abstinence. And if a recent study is any indication, a substantial proportion of men put on condoms after they’ve brought themselves close to ejaculation via penile-vagina intercourse. In that study, 43% of college-age men reported using withdrawal during the initial phases of intercourse, then applying the condom for intravaginal ejaculation.[3] So, can these young couples say that the condom is their method of contraception, or is it really withdrawal?

With the array of more effective contraceptive options, why do couples choose withdrawal? First, it’s a method that’s always available. They can’t “run out” of the method or forget it in their drawer. Second, it’s free, at least up front if you don’t take into account the cost of an unintended pregnancy. In that case, withdrawal becomes one of the more costly of methods. Third, use doesn’t require a physical examination, a visit to a clinic, a discussion with a pharmacist, or an encounter with a cashier. Some couples like that the method involves the male partner.

What difference does the surprisingly high use of withdrawal make to your clinical approach? A lot, actually. With a typical failure rate of 22%, withdrawal falls into the last tier of efficacy. The perfect use failure rate is a reputable 4%, but the quality of use is not under control of the woman at risk, and perfect use can be jeopardized by immediate conditions. Is he under the influence of drugs or alcohol? Can he be counted on to have control over his ejaculation and his withdrawal from the vagina? After all, impending orgasm is a powerful force that can overcome intention for the man or the woman.

What might be your role? Ask directly whether she ever uses withdrawal, even if she uses another method. Take the time to remind her that the method can have a high failure rate. Some couples are at greater risk than others because just over 40% of men have sperm in their pre-ejaculate emission.[4] These men generally do not know that they release sperm then. The amount runs only to about 20 million, so the risk is low, but these sperm are motile. And, as you know. Couples using withdrawal are still at risk for sexually transmitted infections.

–Deborah Kowal, MA, PA, President & CEO, Contraceptive Technology Communications, Inc

[1] Dude A, Neustadt A, Neustadt A, Martins S, Gilliam M. Use of withdrawal and unintended pregnancy among females 15-24 years of age. Obstet Gynecol 2013;122:595-600.

[2] Jones RK, Fennell J, Higgins JA, Blanchard K. Better than nothing or savvy risk-reduction practice? The importance of withdrawal. Contraception. 2009;79:407-410.

[3] Crosby RA, Sanders SA, Yarber WL, et al. Condom use errors and problems among college men. Sex Transm Dis. 2002;29:552–557.

[4] Killick SR, Leary C, Trussell J, Guthrie KA. Sperm content of pre-ejaculatory fluid. Hum Fertil 2010;DOI: 10.3109/14647273.2010.520798.