Withdrawal

Withdrawal is a method of birth control that requires a man to remove his penis from the vagina when he feels he is about to ejaculate. Ejaculation then takes place outside the woman's body, completely away from her vaginal area, to protect her from any contact with his sperm. Withdrawal costs nothing, is always available, and does not require using any devices or chemical-based products. Although it causes no side effects, withdrawal can interrupt intercourse at its climax, or before, and may markedly decrease both partners' sexual pleasure. Because it can have a high failure rate, it may be more acceptable to couples who are interested in spacing—rather than preventing—births.

Men who cannot control their orgasms and men who have premature ejaculations are not very successful in using this method for contraception. Men who use withdrawal need very good control and an awareness of exactly when they are about to ejaculate. It is difficult for a man to remove his penis from the vagina just when his instincts tell him to penetrate further. If he starts withdrawing too late, he may leave some semen at the opening of the vagina, making it possible for sperm to move up into the reproductive tract.

Needless to say, women may not be enthusiastic about this method. It is not easy for a woman to relax completely and reach an orgasm when she is wondering whether her partner will be able to pull out in time or whether he will have to withdraw his penis before she has reached a full sexual response, bringing a sudden, uncomfortable end to lovemaking. It also puts the man completely in control of the sex act and of contraception, unless the couple uses one of the control techniques described below that help men control arousal and postpone ejaculation.

On the other hand, couples who have been together long enough to understand each other's sexual rhythms may be able to achieve satisfactory sexual responses when using withdrawal.

Withdrawal provides no protection against sexually transmitted diseases, including AIDS.

EFFECTIVENESS

Calculating the effectiveness of the withdrawal method is difficult. Only 2 percent of couples in the United States use this method. In a 1990 analysis, the lowest failure rate was 4 percent in the first year when withdrawal was reported to be used perfectly. More typical users had a failure rate of 19 percent during the first year.

USING WITHDRAWAL

Couples who communicate well and can be cooperative in their lovemaking are more likely to be successful in using this method. Moreover, control techniques do exist (see below), such as the "squeeze" technique and the "stop-start" method, that can make withdrawal more effective and more pleasurable for both partners.

In practicing withdrawal, before the penis is inserted the tip should be carefully wiped off to remove any pre-ejaculate fluid. Although it is not known whether pre-ejaculate carries many sperm, to be on the safe side any fluid should be removed. You may wish to keep a box of tissues handy for this purpose, for cleaning up ejaculate and, perhaps, for ejaculating into.

A backup spermicide could be somewhat useful in case semen accidently spills into the vaginal opening or vagina. Adding spermi-

IN A NUTSHELL

WITHDRAWAL

This is a method used by a man in which he withdraws his penis from the woman when he feels he is going to come (ejaculate). He then ejaculates outside her body. There are a couple of techniques that make this method easier, but withdrawal requires great control and much practice. It also decreases sexual pleasure for both partners.

Withdrawal costs nothing and is always available, but it has a high failure rate. It is used mostly by married couples who want to space their children.

Withdrawal does not protect against disease. A condom plus a spermicide are the best safeguards against STDs and AIDS for sexually active people.

cide afterward may futile, however, because sperm move so rapidly. Douching definitely is not helpful and may actually speed sperm on their way.

Control Techniques

Two exercises have been practiced successfully for many years to help men control their sexual excitement and postpone ejaculation. Both exercises—the "squeeze" and the "stop-start"—require the willingness and cooperation of both partners. Used regularly, the exercises can be quite successful.

The Squeeze Technique. The penis squeeze technique has been employed for many years by Masters and Johnson and other sex therapists to help men overcome a tendency toward premature ejaculation. It can be a very helpful exercise for couples who wish to practice withdrawal, because it gives the man greater control over the timing of his orgasm, thus prolonging the sexual pleasure of each partner and increasing the efficacy of this method.

The couple may stroke and caress each other's genitals, including the penis, without penetration taking place, up to the time when the man senses he is about to ejaculate. He signals this to his partner, who immediately takes the penis in her hand, placing her thumb just underneath the tip (the glans), with her forefinger and middle finger across the top of the glans—one finger on each side of the bump (the coronal ridge). If the man is uncircumcised, the woman can feel the coronal ridge through the foreskin covering the glans, but the place underneath the glans where she should press her thumb may have to be located by guesswork.

When the penis is erect, squeezing it firmly usually causes no discomfort, although this is not true for every man. This should halt his immediate urge to ejaculate, yet have only a slight softening effect on the erection. Because the response to such pressure is individual, couples may wish to experiment to determine just how much pressure is necessary to be effective. With her fingers in the position described, the woman exerts as much pressure as needed for 4 or 5 seconds. (Some women may have to use both hands to be effective.)

When the man feels his impulse to ejaculate has worn off sufficiently, which may take anywhere from a few seconds to a few minutes, sexual stimulation can be resumed, with the expectation that the urge to ejaculate will be postponed for about 10 to 20 minutes.

When the man has developed a certain amount of control over his ejaculation, it is then possible for the couple to go a step further, to vaginal penetration combined with the squeeze technique, to prolong intercourse. They may use the spoon position or the woman may place herself above the man. When he is about to ejaculate, he warns her, and she immediately removes his penis from her vagina and uses the squeeze technique to stop his orgasm. This approach is safe as long as the man lets his partner know when an orgasm is imminent. Obviously, it is important that he not wait until the very last minute, when it is too late for the squeeze to work.

The Stop-Start Method. Instead of—or in addition to—the squeeze technique, ejaculation can be delayed and intercourse prolonged by the stop-start or stop-and-go method. This means intercourse is prolonged by completely stopping all sexual stimulation, including thrusting with the penis, as soon as ejaculation becomes imminent. After about 30 seconds of quietness, the intense desire to ejaculate begins to ebb. When the urge has noticeably subsided, lovemaking is resumed.

Both of these exercises require practice before they feel easy and natural. As the techniques are repeated, the man becomes accustomed to receiving prolonged pleasure from sexual stimulation. He achieves greater mastery over his ejaculation and becomes able to postpone his orgasms for long periods.

As a couple uses these exercises to help the man develop more control of his sexual performance, the woman may also have to find when she is most stimulated to having an orgasm. In the beginning, it may be safer for her to have her orgasm before or after her partner approaches his climax, so she can assist in the withdrawal technique. As he gains more control over his arousal so that sexual stimulation for both of them can be drawn out, the woman may have more time in which to reach her climax. With practice, each partner may be able to experience more than one orgasm and still practice withdrawal effectively.

The Spoon Position

The spoon position makes it easier for both partners to exert some control over the man's ejaculation and for him to withdraw. The man and woman curl up together on their sides, with the man behind the woman. This position allows him to hold her closely and to caress her, while at the same time the angle of their bodies makes it impossible for his penis to penetrate too deeply into her vagina.

The spoon position is comfortable for the woman and permits her to stroke her partner's penis and to enjoy his stimulation of her breasts and clitoris. Her legs are together rather than apart, which also helps control the deepness of her partner's thrust.

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