I am currently researching the withdrawal birth control method and would like to sum up some of my findings, ask some questions, and hopefully generate some discussion.

I have spent a significant amount of time scouring the web and reading about withdrawal as a method of birth control. A study by the FDA (http://www.fda.gov/Fdac/features/1997/con ceptbl.html) states that, for typical users, withdrawal is 81% effective at preventing pregnancy. With perfect use, it can be as high as 96% effective. For comparison, the same study found that condoms are 86% effective for typical use, and 97% effective for perfect use. So, based on this study, the effectiveness of withdrawal is comparable to that of condom use. There may be other, more recent studies available from sources which are equally as reputable as the FDA, and if anyone knows where I can access these, please let me know.

One thing I would like to better understand is the causes of failure for this method. So far, I've found three primary causes of failure that seem pretty obvious and more or less agreed upon across the web:

a) Men sometimes aren't able to control themselves enough to withdraw before ejaculation starts, thus expelling semen before withdrawing, causing pregnancy b) When a man withdraws, semen may come into contact with the outer vaginal area during ejaculation and could enter the vagina, causing pregnancy c) Semen from a previous ejaculation may exist in the urethra, and could be picked up by pre-ejaculate during intercourse and expelled into the vagina, causing pregnancy

These failures can be avoided by a) withdrawing well before ejaculation instead of waiting until ejaculation is imminent, b) ejaculating away from the vaginal area, ensuring that no semen comes in contact with the vagina, and c) flushing the urethra of semen from a recent ejaculation by urinating.

There is one more cause of failure that is heavily debated across the web. Failure cause d) pre-ejaculate contains sperm and is expelled during intercourse, causing pregnancy. This is different than cause c) in that many arguments claim pre-ejaculate itself contains sperm, regardless of a recent ejaculation. The opposing arguments claim that since pre-ejaculate comes from the Cowper's gland, which is closer to the urethral opening than the ejaculatory ducts, it does not come into contact with sperm before ejaculation and therefore does not contain sperm when it is expelled through the urethral opening.

Keeping a rough tally of both sides, it seems more people make the statement that "pre-ejaculate contains sperm" than those that claim the opposite. However, I can't seem to find any studies or publications that provide scientific evidence supporting the presence of sperm in pre-ejaculate. Those who make this statement never cite references, which makes it difficult for me to trace its origin.

On the other hand, the opposing arguments have citations backing them up. For example, the following links refer to health-related journals whose findings support the "no sperm in pre-ejaculate" claim.

http://www.ncbi.nlm.nih.gov/pubmed/1228690 5 http://ehealthforum.com/health/topic122910 .html

I don't consider these to be definitive proof by any means since the studies were performed on small numbers of test subjects, but at the same time, I haven't yet found publications which report to the contrary of these.

One question that is worth discussing: If there is, in fact, sperm present in pre-ejaculate, how does it get there? Another question: If sperm is not present in pre-ejaculate, why isn't withdrawal 100% effective when used perfectly? Based on the FDA study mentioned above, sperm is obviously coming from somewhere. If "perfect use" means avoiding a), b), and c) above, and pre-ejaculate contains no sperm, why is there still a 4% failure rate? Could this be statistical noise?

I'm looking forward to the discussion.