Dear Doctor,

I have been with my boyfriend for three years. We started having sex and we use the withdrawal method. How safe is it and how can we make it even safer? Thank you.Janet, Kimironko

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Dear Janet,The withdrawal method or coitus interruptus is a very old method to prevent unwanted pregnancies. As per history it was practised in ancient Greece and Rome, where people preferred small families as compared to big ones.In this, as you have been practicing, the male partner withdraws before ejaculating semen in the vagina of the female partner. It is very economical and effective in most of the cases. However the failure rates of this method have been stated to be as high as 4%. Failure could be due to lack of withdrawal at the correct time. It could also be due to an amount of semen passed during pre-ejaculation, i.e. small amount of seminal fluid passed before actual ejaculation. Multiple studies have shown a very small negligible amount of semen or no semen in the pre-ejaculation fluid. However the possibility of this small amount of semen impregnating a woman is very rare. More than this risk, there is the risk of psychological trauma with this method. Many male partners may feel dissatisfied due to withdrawing before ejaculating inside which gives a sense of complete satisfaction. If they are not completely mentally prepared for this, over a time one may feel frustrated thus jeopardizing a relationship. Some women also do not feel completely satisfied till they experience the wetness inside.One thing should be understood very well by any couple practicing coitus interruptus. It prevents any unwanted pregnancy but does not protect against sexually transmitted diseases or even infections like hepatitis B or HIV/AIDS. It should not be considered as a barrier method like a condom or diaphragm. Hence this method should be adopted only when one is sure that there is no risk of acquiring these infections. To put it simply, it should be used when one has a steady, known partner and should never be tried with unknown partners.You have made a very good choice by adopting this method of contraception. Practiced regularly it is very effective. I know friends who have used this technique for more than 15 years and have only 2 children. Determination on part of both partners is needed to make this method successful. Delay of even a few seconds can lead to failure and an unwanted pregnancy. Both partners should be mentally prepared for it and there has to be mutual agreement.  Leisurely, foreplay before starting intercourse can give sense of satisfaction, hence no feeling of depression or tension will occur afterwards. To make it more effective make sure that you do not experience even one drop of wetness.Dr. Rachna Pande