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.
- 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
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.
Emergency contraceptives like Julie work when you take them after sex. That’s because emergency contraception prevents pregnancy by delaying when you ovulate. By taking emergency contraception before sex, you may not be delaying ovulation long enough.
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.
Julie is an emergency contraception you can take after:
- You didn’t use any form of birth control or had unprotected sex
- There was an issue with your regular birth control method (eg, the condom broke or slipped)
- You missed a dose (or more) of your regular birth control pill
Taking Julie will not impact your ability to get pregnant.
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.
Julie can be used by all women, regardless of weight but women with BMIs above 29.9 have a pregnancy risk of 5.8% - meaning that out of every 100 women who take Julie, 6 may become pregnant. We advise that you speak with your doctor for further information on how this may affect you personally.
Take Julie tablets orally (swallow it). It is preferable to take it with water, and you can take it with or without food. Do not insert Julie vaginally.
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.
Julie is effective up to 72 hours (3 days) after unprotected sex. The sooner it’s taken after unprotected sex, the better it works.
Julie can significantly decrease your chances of getting pregnant. When used as directed, about 7 out of every 8 women who could have gotten pregnant will not become pregnant after taking Julie. The most important factor affecting how well Julie works is how quickly it is taken. When taken as directed within 72 hours after unprotected sex or birth control failure, Julie can significantly decrease the chance that a woman will get pregnant. In fact, the earlier Julie is taken after unprotected intercourse, the better it works.
Emergency contraception is not 100% effective, which is why it is critical that women have a regular birth control method. If you have any further questions, we encourage you to talk to your healthcare provider.
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. 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.
You do not need to see a doctor before or after taking Julie. You do not need a prescription from a doctor. We do encourage you to speak to a doctor you feel comfortable with about sex, reproductive health, and contraception.
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!
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.
