by Dr. Tessa Commers
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.

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.

  1. Head to the bathroom and urinate—that can help remove semen on the outside of your vagina.
  2. 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.
  3. 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

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.

Birth Control

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

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.