Dear Alice,

My girlfriend and I have begun having sex recently. The first few times we did, we used condoms. Lately, we haven't. I always pull out before I come. Is this still safe? Is it safe to re-enter after this? Someone told me that if we don't want to use a condom, we should use a spermicide. Is this safe by itself? I appreciate all that help. Thanx.

Dear Reader,

First, it’ll be good to clarify what you're trying to prevent: sexually transmitted infections (STIs), pregnancy, or both? For pregnancy prevention, both pulling out (or withdrawal) and spermicide are acknowledged birth control methods. However, it’s good to know more about the details of these options and their respective effectiveness rates (more on that in a bit) to determine if either are for you and your partner moving forward. In the case of STI prevention, pulling out isn’t considered an effective risk-reduction method because some infection-causing microorganisms can be spread without ejaculation, such as through skin-to-skin contact or other bodily fluids. A condom will only help prevent the spread of STIs if you put it on before sex and leave it on the entire time you're having sex, acting as a barrier between partners. If both of you were tested before you started having sex with each other, you may not be concerned about STIs. If you haven't been tested, you may want to consider doing so. You can visit your health care provider or a health center such as Planned Parenthood for STI testing and related services.

Back to the deets on pulling out: As a method of birth control, it has been found to be as high as 96 percent effective at pregnancy prevention with perfect use and 78 percent effective with typical use. Perfect use indicates correct and consistent use of the method every single time you have sex. Typical use reflects the effectiveness rate of an average user… who sometimes forgets to pull out in time before ejaculating, for example. As a side note: all methods of birth control have these dual rates, to help users make informed choices about which methods might work for them, their partners, and their lifestyle(s). But wait, there’s more to consider!

Pulling out as a method boasts a few advantages. It's free and always available — no devices, prescriptions, or trips to the store are necessary. Second, no side effects are associated with this form of contraception. That said, as a primary means of pregnancy prevention, withdrawal also has several disadvantages. One key factor is the issue of pre-ejaculatory fluid or pre-cum. While the fluid itself doesn’t usually contain sperm, research has found that it sometimes can for some folks. Additionally, pre-cum may also pick up sperm left in the urethra (the tube that moves semen and urine from the body for those with a penis) from a previous ejaculation, and thus, re-inserting your penis after ejaculation (outside of the vagina) does present a risk of pregnancy. What may further impact its effectiveness is the issue of consistency and self-control. A question to ask yourself is whether you can use the withdrawal method correctly and consistently (pulling out prior to ejaculation) each time you have sex. If not, then you might want to think about whether this method is right for you and your girlfriend. Of course, you do have the option of emergency contraception.

You also mentioned potentially using spermicides. Used alone, spermicides have one of the lowest effectiveness rates of all methods of birth control — with perfect use effectiveness at 82 percent and typical use effectiveness at 72 percent — which is even lower than withdrawal! If pregnancy prevention is a primary concern for you and your partner, there are other methods that have higher effectiveness rates that you may consider. However, you could use a spermicide in addition to withdrawal. The spermicide would offer a "back-up" in the event that you don’t pull out in time. Most drug stores and pharmacies sell a variety of spermicides — you and your girlfriend may want to experiment with a few to find one that works best. Though spermicide is typically easy to use and find, it does have some potential downsides. Some folks experience urinary tract infections (UTIs) or vaginal irritation due to the use of spermicides. When used frequently, spermicides may also increase the risk of HIV transmission, as it may irritate the skin and make it easier for the virus to get into the body. If you (or your partner) discover that the use of spermicide irritates your skin, you may want to consider a different method of contraception.

No type of sexual contact is without risk and it’s key to weigh the pros and cons of prevention — so kudos to you for asking for more information. If you haven't already, perhaps you and your girlfriend could talk about your concerns and work toward reaching a mutual decision on what form(s) of contraception and safer sex practices you both want to use. Besides the issue of STIs, consider how willing you are to risk pregnancy and what either of you would do if it occurred. Withdrawal is definitely less effective than, say, the birth control pill. But, if both of you are okay and comfortable with the risk involved, then you may decide that withdrawal is a method that will work for the two of you. Making a visit to your health care provider to further discuss your contraceptive options may also be in order. In the meantime, you can check out the Contraception category in the Go Ask Alice! Sexual and Reproductive Health archive for additional reading and research.

Stay safe!

Alice!

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