Julie Medical Advisor
The pull out method: explained by a doctor
“Pulling out” (aka, withdrawal or coitus interruptus) is a birth control method that involves pulling the penis out of the vagina before ejaculation and releasing ejaculate away from the genitals. People have used this method to prevent pregnancy for years, but how effective is it? Julie’s Head of Medical Education, Dr. Tessa Commers, explains everything you’ve ever wanted to know about pulling out.
Can you get pregnant from the pull-out method?
Yes. It’s possible to get pregnant from the pull-out method, but when done correctly, the chances of pregnancy are reduced.
There are two main ways you can get pregnant from the pull-out method. The first is getting caught up in the moment and not pulling out before ejaculation. The second is pre-cum. It only takes one sperm to become pregnant. Pre-cum can carry sperm, and cum near the vaginal opening can get inside and result in a pregnancy.
About one in five couples that use the pull-out method during a single calendar year will get pregnant. Not pulling out in time, especially during ovulation, creates a higher risk of pregnancy.
That being said, pulling out is better than not using birth control at all. However, if you use the pull-out method, it’s best to combine it with another method, such as condoms or birth control pills, for added protection.
Can you get pregnant during ovulation if you pull out?
You’re most likely to become pregnant from unprotected sex in the few days leading up to and for 24 hours after ovulation. So if you decide to use the pull-out method when you’re ovulating, be sure to use another form of birth control or have emergency contraception, like Julie, on hand. Abstaining from unprotected sex on the five days before and one day after ovulation (usually around 6 days total) is another way to protect yourself from pregnancy. Here’s how to tell if you’re ovulating.
If the ovulation process has already started, the morning-after pill will not be effective since it works by stopping or delaying ovulation. However, there are other emergency contraceptive options that are still effective during ovulation, like the copper or high-dose hormonal IUD, both of which are over 99% effective if inserted within 5 days of having unprotected sex.
How well does it work?
The pull-out method does work. In fact, the Cleveland Clinic says it’s about 80% effective. However, effectiveness depends on how well you and your partner use it—aka if your partner pulls out in time—and if you have another form of birth control as a backup.
The biggest issue with pulling out is that your partner has to do it while they, or both of you, are experiencing heightened stimulation (basically, when sex feels really, really good). It’s not easy to do. But practicing with a condom can help your partner get a better understanding of when they’re about to ejaculate.
Does it prevent STIs?
No. Pulling out does not protect against STIs, which is another reason why this method isn’t ideal when used on its own.
STIs are transmitted through blood, ejaculate and pre-ejaculate, and other skin-to-skin contact, so it’s still possible to contract one or give it to your partner even when using the pull-out method.
The best way to protect against STIs like gonorrhea, genital warts, chlamydia, herpes and syphilis is to wear a condom.
Signs of pregnancy after pulling out
There’s no immediate way to tell if you’re pregnant after pulling out or failing to properly pull out because you’re not immediately pregnant after sex. It can take up to 6 days for the sperm to fertilize an egg and another week or so for a pregnancy to officially develop.
If you’re concerned that your partner might not have pulled out in time, there are some things you can do immediately after sex.
- Head to the bathroom and urinate—that can help remove semen on the outside of your vagina.
- You can also use your vaginal muscles (think Kegels) to push out any ejaculation inside you. Keep in mind this doesn’t eliminate all of the sperm inside, but it can help reduce the amount. Then wash the outside of your genitals.
- You may also want to take emergency contraception, like Julie, as an added backup
How to pull out most effectively
The golden rule for using the pull-out method most effectively is the earlier, the better. The sooner you pull out before ejaculation, the better it will work in preventing pregnancy.
Pulling out requires your partner to know their body well enough so they can tell when they’re about to ejaculate. It’s also reasonable to ask the person with a vagina to participate in this method. Establishing physical or verbal cues (like a squeeze on the shoulder or saying “I’m close”) can indicate to a partner to separate.
Most of the time, the pull-out method fails because the partner doesn’t pull out soon enough. But you can both work together to ensure it’s done at the right time.
Tips for pulling out effectively:
- Communicate your pleasure levels and verbalize when you’re getting close to climax
- Practice pulling out while using other forms of birth control (like a condom) to get a feel for the threshold
- Try having your partner pull out before he’s close to climax and he or you can stimulate his penis until he ejaculates
Should I take Plan B or Julie for pre-cum?
Taking Plan B or Julie after unprotected sex is always a good idea. While pre-cum typically has very little sperm, it only requires one sperm to fertilize an egg and ultimately lead to pregnancy. A study involving a small sampling of men found that 41% had sperm in their pre-cum (pre-ejaculate). While the majority of people do not get pregnant from pre-cum, it is possible. If you want to be safe and have the best shot at avoiding pregnancy, taking the morning-after pill like Julie or Plan B is essential.
What are the side effects of the pull out method?
Unlike other birth control methods, the pull out method typically comes with no side effects. However, some people do experience anxiety, worry, or fear as they wonder if they or their partner pulled out in time and/or if they could be ovulating. If you used the pull out method after unprotected sex and are not sure if sperm could have entered your vagina, then taking the morning-after pill like Julie can be very helpful.
How likely are you to get pregnant without protection?
You are at a higher risk of pregnancy when you have sex without using any protection. In fact, about 85 out of 100 women who are sexually active and don’t use any form of birth control, including condoms, are likely to become pregnant within a year. If you recently had sex without protection or if your protection failed, the morning-after pill, like Julie, can be 89% effective at preventing pregnancy if taken within 72 hours.
The pull-out method and ovulation
You’re most likely to become pregnant from unprotected sex in the few days leading up to and during ovulation. So if you decide to use the pull-out method when you’re ovulating, be sure to use another form of birth control or have emergency contraception, like Julie, on hand. Abstaining from unprotected sex on the five days before and one day after ovulation (usually around 6 days total) is another way to protect yourself from pregnancy. Here’s how to tell if you’re ovulating.
If the ovulation process has already started, the morning-after pill will not be effective since it works by stopping or delaying ovulation. However, there are other emergency contraceptive options that are still effective during ovulation, like the copper IUD, which is over 99% effective if inserted within 5 days of having unprotected sex.
How to prevent pregnancy effectively
While the only birth control method that’s 100% effective is abstinence, there are many ways to significantly reduce your chances of getting pregnant. Check out 18 ways to prevent pregnancy.
Where emergency contraception can be used as a backup method in cases of unprotected sex, daily birth control is more effective at preventing pregnancy on a regular basis.
Many types of birth control options exist, including hormonal, non-hormonal, or barrier protections.
- Hormonal birth control options contain synthetic hormones. They include daily birth control pills, the shot, implant, patch, and levonorgestrel IUD. Some hormonal options have a lower dose than others, which can be helpful if your body is sensitive to the added hormones.
- Non-hormonal birth control like the copper IUD.
- Barrier methods of pregnancy protection include condoms and diaphragms.
Emergency contraception is a safe way to prevent pregnancy up to 120 hours (5 days) after unprotected sex. The sooner you use emergency contraception, the better.
There are a few different types of emergency contraception, and some can differ in effectiveness due to the person’s weight.
Emergency contraception is not an abortifacient and will not affect or end an existing pregnancy.
Approved methods of emergency contraception include:
- Levonorgestrel pills (aka the morning-after pill): these pills, like Julie and Plan B One-Step, contain 1.5 mg of levonorgestrel, a synthetic hormone used in daily birth control pills that delays ovulation (when an egg is released from an ovary). When no egg is released, there’s nothing for sperm to fertilize, and thus no chance of pregnancy. These pills are legal, FDA-approved, and available in all 50 states. Effectiveness may be reduced for people with a BMI over 25. They work best when taken within 3 days of unprotected sex.
- Ulipristal Acetate (Ella): this type of morning-after pill is only available via prescription by a clinician. Ulipristal acetate works similarly to levonorgestrel in delaying ovulation, but it is more effective for people who have a BMI above 25. Effectiveness may be reduced for people with a BMI over 30.
- Intrauterine devices (IUDs): the copper and levonorgestrel IUDs are small t-shaped devices that are inserted into the uterus by a physician. They are over 99% effective when inserted within 5 days of unprotected sex and are not affected by weight. IUDs are a standard form of birth control, lasting 8 or more years. However, an appointment and insertion procedure are required.
Although the information above may be useful, it shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your healthcare professional.
There are a few medications that may interact with the morning-after pill. The most common medications include:
-Some anti-HIV medications
-Some anti-seizure medications
-Rifampin (an antibiotic mainly used to treat tuberculosis)
-St. John’s wort
If you have concerns about a medicine you are taking potentially interacting with the morning-after pill, please consult with a pharmacist or medical provider.
No, studies have confirmed that taking two pills will not change the effectiveness of the morning-after pill, even for those with higher BMIs.
Essentially nothing. Julie is not an abortion pill and it will not harm or end an existing pregnancy. Julie helps prevent pregnancy by stopping or delaying ovulation, but if you’re pregnant, then there’s no ovulation to stop. The medication, levonorgestrel, won’t harm you or your fetus if you do end up taking Julie while pregnant. This makes Julie a great option for people who want to be safe after unprotected sex—if you aren’t pregnant yet, it may stop a pregnancy from occurring, and if you are already pregnant, it won’t impact the fetus.
No. The morning-after pill only stops ovulation short-term. When you take it after unprotected sex, it reduces your chance of getting pregnant now. When you start a new cycle next month, you’ll go through a brand new ovulation phase, which is a new opportunity to get pregnant. So if you’re planning on having babies in the future, rest assured your chances of getting pregnant won’t be affected by Julie.
After taking Julie you can continue on with your regular birth control method if you have one (for example, continue taking birth control pills).
You will know Julie has been effective when you get your next period, which should come at the expected time, or within a week of the expected time. If your period is delayed beyond 1 week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional.
Julie is a backup or emergency method and should not be used as a regular birth control method. Consult with your doctor about a birth control method that makes sense for you.
Please know that taking a dose of Julie will only protect you from one instance of unprotected sex, it will not prevent pregnancy from unprotected sex over the coming days or weeks. If you have unprotected sex in the future and want to prevent pregnancy, be sure to take a new dose of Julie and talk to your doctor about the best birth control options for you.
Your menstrual bleeding patterns may change temporarily after using levonorgestrel. If you find that your period is more than a week late, take a pregnancy test to confirm whether the contraceptive has worked.
Technically, no. Julie can be used by anyone with a uterus regardless of weight. However, studies have shown that the effectiveness of the morning-after pill does decrease in people who have a body mass index (BMI) over 25. For those with a BMI under 25, pregnancy risk after taking the morning-after pill is less than 2%. For those with a BMI over 29.9, the risk of pregnancy increases to 5.8% - meaning that out of every 100 individuals with a BMI over 29.9 who take Julie, six may become pregnant.
Why? Unfortunately, we don’t really know. There is only preliminary research testing the efficacy of the morning-after pill on people with a BMI over 25 and 30. Read more here.
Julie is not an abortion pill and will not harm an existing pregnancy nor will it be effective if a woman is already pregnant.
Julie is a progestin‑only emergency contraception product that helps prevent pregnancy before it starts when taken within 72 hours after unprotected sex.
Julie is a backup method of preventing pregnancy and should not be used as regular birth control. Use as directed.
The medication in the morning-after pill, levonorgestrel, temporarily blocks or delays ovulation, which is when your ovary releases an egg. It essentially puts the emergency brakes on your ovaries so an egg can’t be released. If there’s no egg, then there’s nothing for sperm to fertilize, which means a pregnancy can’t develop.
Read more about how the morning-after pill works here.
The morning-after pill, like Julie, is 89% effective when taken within 72 hours (or 3 days) after unprotected sex. The golden rule is the sooner you take it, the better it will work.
One thing to note: Weight does impact the effectiveness of the morning-after pill. If your BMI is over 25, Julie may not be the best option for you, but there are other options if you have access to a medical provider. Ella® is another type of emergency contraception pill that works more effectively for women with a BMI under 30. Like Julie, it’s a one-time pill but it does require a prescription from your provider. Copper and hormonal IUDs are the most effective form of emergency contraceptive and are not affected by weight at all. However, they do need to be inserted by a healthcare professional up to 5 days after having unprotected sex.
Learn more about how weight impacts Julie here.
You do not need to see a doctor before or after taking Julie because the pill is available without a prescription. However, there are a few reasons you might want to speak with a doctor after unprotected sex. The first reason is that unprotected sex carries the risk of catching sexually-transmitted infections. The second reason is that the morning-after pill is not as effective as regular birth control. A doctor will be able to counsel you on better options if you plan to remain sexually active.
Since emergency contraception can affect the length of your menstrual cycle, your period might come about a week later or earlier than usual after taking Julie. If your period is more than one week late, consider the possibility of pregnancy.
No, the morning-after pill (including Julie) and the abortion pill are two very different medications. The morning-after pill prevents a pregnancy from starting by stopping an egg from being released. If there’s no egg, there’s no chance of pregnancy. Plus, it’s FDA-approved and legal in all 50 states.
On the other hand, the abortion pill ends an existing pregnancy, which is something that the morning-after pill cannot do. If you’re already pregnant, the morning-after pill and the medicine within it, levonorgestrel, cannot end the pregnancy or impact it in any way.
See more common morning-after pill myths here.
No. No one needs a prescription to purchase Julie or EC. However, some insurances require a prescription for reimbursement. Some pharmacies and places where EC is sold may tell you that you need a prescription. You do not.
The morning-after pill—like Julie— is one of the most common and convenient forms of emergency contraception. It’s an over-the-counter pill found at retail chains like Target, CVS, and Walmart nationwide. The morning-after pill is made of the hormone levonorgestrel, the same hormone found in many birth control pills and is FDA-approved and legal in all 50 states. When used correctly, it can significantly reduce your chance of getting pregnant. It doesn’t require a prescription, ID, or credit card, and can be purchased easily by anyone (you, your partner, your friend, or the nice guy from GoPuff). Learn more about the morning-after pill here.
The morning-after pill is a backup method of preventing pregnancy and should not be used as regular birth control.
You should take Julie if you had unprotected penis-to-vagina sex and:
- You didn’t use any form of birth control
- Your birth control method failed—e.g. the condom broke or slipped off
- You missed 2 or more doses of your regular birth control pill
- You’re not sure if he pulled out in time
Remember to take Julie ASAP to have the best chance of it working. It’s 89% effective when taken within 72 hours of unprotected sex, but can be effective up to 120 hours after. Learn more about Julie here.
No. No one needs a prescription to purchase Julie or other brands of the morning-after pill. However, some insurance companies require a prescription for reimbursement. Some pharmacies and other places where emergency contraceptives are sold may tell you that you need a prescription. You do not.
Take the Julie tablet orally (swallowed). It is preferable to take it with water, and you can take it with or without food. Do not insert Julie vaginally.
No. We know this is a common misconception so let’s break it down. Using Julie (no matter how many times you take it) does not affect your fertility — and it will not prevent you from becoming pregnant in the future. You should feel free to use Julie whenever you think it’s necessary. Julie (and all EC) is not recommended as an ongoing form of birth control because it’s not as effective at preventing pregnancy as birth control methods like the IUD, patch, pill, ring, or shot. Also, frequent use of EC may cause periods to become irregular and unpredictable. That’s it!
You can get Julie at your local CVS, Target, Walmart or on our website.
No, that’s not recommended. Emergency contraceptives, like Julie, work when you take them after sex. That’s because emergency contraception prevents pregnancy by delaying when you ovulate, which is when an egg is released from the ovary. Sperm can live inside you for up to 5 days, so if you take Julie and then have unprotected sex, the medication might not be able to delay ovulation for the entire length of the sperm’s life, creating a potential for pregnancy.
Learn more about how Julie works here.
Yes. You are not alone. Often times, people who buy EC are feeling stressed out, concerned, embarrassed, confused or ashamed. The important thing to remember is that you are not alone, you have nothing to be ashamed about, and the Julie community is here to support you. By taking Julie after unprotected sex, you are taking control of your future and taking a safe, effective, approved method of preventing pregnancy.
Julie and other over-the-counter morning-after pills contain a high amount of levonorgestrel, a synthetic hormone that’s also in some birth control pills. The extra amount of this hormone can affect your menstrual cycle and cause some side effects. Most side effects come and go within hours of taking the pill, but some can last up to a couple of days. Learn more about Julie's side effects here.
- Bleeding/spotting between periods
- Temporary changes to a period cycle (the next period comes early or late)
- Heavier or lighter next period
- Abdominal pain
- Breast tenderness
For more information about Julie side effects and how long they last, read this.
Side effects like nausea, abdominal pain, and fatigue can start within a few hours of taking the morning-after pill. If you vomit within two hours of taking the pill, it’s important to talk to a healthcare professional to find out if you should take another dose.
Most side effects are easily manageable, but sometimes they can be annoying. If that headache just won’t go away or your breasts are super tender, it’s safe to take ibuprofen, acetaminophen, or any over-the-counter pain reliever—they won’t interact or interfere with levonorgestrel.
Listen to your body. After all, you’ve just taken a pill that affects your hormones. Feeling a little weird is normal. Rest, keep yourself hydrated, and give yourself some extra compassion.
No. Julie is not what is commonly called “the abortion pill” or “medication abortion”. The active ingredient in the abortion pill is mifepristone. Pregnancy needs a hormone called progesterone to grow normally. Mifepristone blocks your body’s own progesterone, stopping the pregnancy from growing. Julie does not and will not impact an existing pregnancy, and works by delaying ovulation before there is a pregnancy.
The FDA recently made an update in December 2022 to remove any language suggesting that Julie may prevent implantation of a fertilized egg. We are currently working on removing this outdated disclaimer but you may still see it present on some of our packaging in the meantime. Please disregard these statements because they are out of date. Julie will not impact an existing pregnancy.
Your cycle might be temporarily affected after taking Julie. That’s because there’s a higher dose of levonorgestrel compared to what’s found in daily birth control pills. It’s likely to impact your body’s natural hormone levels for a short period of time. This might result in an earlier or later period.
If your period is delayed beyond one week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional if positive. Your period might also be lighter or heavier than usual, or you might experience spotting in between cycles. If your schedule is impacted beyond a month or two, it’s worth checking in with your medical provider. Read more about how Julie might affect your period here.
No! The most common side effects are changes in your period, nausea, lower stomach pain, fatigue, headaches, dizziness, and breast tenderness. These symptoms typically go away within a few hours and shouldn’t last more than a couple of days. If you have any side effects that bother you, call your healthcare professional. Read more about Julie's side effects here.
Yes. You are not alone. Oftentimes, people who buy EC are feeling stressed out, concerned, embarrassed, confused or ashamed. The important thing to remember is that you are not alone, you have nothing to be ashamed about, and the Julie community is here to support you. By taking Julie after unprotected sex, you are taking control of your future and taking a safe, effective, approved method of preventing pregnancy. If you want to share your experience and talk with others in our community, head to our Tik Tok, Instagram, and Quora space, After Sex, where all sex questions and commentary are welcome.
It depends. Some people get their period a few days earlier or later than they were expecting, while some have reported a delay in menstruation beyond a week. Stress can also delay your period, which can be heightened when taking emergency contraception. If your period is more than one week late, it doesn’t necessarily mean that you’re pregnant, but it is recommended to take a pregnancy test.
Waiting for your period to arrive can be stressful, especially after taking emergency contraception, but just know that it might be totally normal. A delayed or early period is actually one of the most common side effects of taking the morning-after pill. Levonorgestrel, the hormone in Julie, delays ovulation, which can move the timing of your cycle back a few days. Your period might also be lighter or heavier than usual, or you might experience spotting in between cycles. If your period is delayed beyond one week, it doesn’t necessarily mean that you’re pregnant, but it is recommended to take a pregnancy test. You can read more about how Julie might affect your period here.
The best thing to do after taking Julie is to rest and hydrate. If you’re feeling any side effects, you can take over-the-counter painkillers to make yourself feel more comfortable. A heating pad or hot water bottle can also help if you’re having stomach pain or cramping. If you can, a day on the couch with Netflix or a good book often does the trick. Read more about managing Julie side effects here.
Typically just for one menstrual cycle. Most people notice that their period starts either a few days early or a few days late, though some people have reported a two-week delay in menstruation. If you are not pregnant, your cycle should return to normal the next time you get your period. If changes last beyond a month or two, it’s best to check in with a doctor.
Read more about changes to your period after taking Julie here.