Who Needs Condoms When You Can Pull Out?

Last month, the Guttmacher Institute released a controversial report [2] showing that the much-maligned withdrawal method, when used correctly, is almost as effective in preventing pregnancy as condoms are. Withdrawal is also increasingly popular: The report cites CDC data showing that the number of women who have used it went up almost 15 percent from 1995 to 2002. Meanwhile, CDC data also shows that as women get into their late 20s and early 30s, they use condoms less and less, even if they’re not married.

My theory, based on an admittedly small sample of educated twentysomethings, is that there’s a connection here between the condom ebb and the withdrawal flow, so to speak. Many of my friends have admitted to ditching condoms and adding withdrawal to their contraceptive repertoire, even when they’re not on the Pill. These women say that they’re not afraid of the STDs that condoms protect against. And to the extent they think withdrawal still poses a greater risk of pregnancy, well, they’re not worried about that the way they used to be.

A year before the Guttmacher study came out, a 27-year-old friend, let’s call her Amanda, started using withdrawal with her new boyfriend. “I mean, there are really not that many days per month that you can get pregs, and if you are pretty regular it's not rocket science,” she says over instant message.

Amanda’s gynecologist insisted otherwise, which isn’t a surprise. Even though, as the Guttmacher study points out, withdrawal has played a major role in the European fertility decline, it goes against everything American public health experts have been preaching for decades. In the 1990s, when my friends were in high school, Madonna did PSAs [3] encouraging condom use. TLC’s Lisa “Left Eye” Lopez pranced around with a condom eye patch [4]. We all dutifully learned about dental dams even though I never met anyone who actually used one. We absorbed the message that latex-free sex was incredibly reckless behavior.

But is it really? It’s irresponsible not to use a condom for casual sex, but for affluent women, it’s not actually a dire risk. Statistically, the vast majority of women who contract HIV are low-income women [5] and IV drug users. Meanwhile, the chronic STDs middle class young women do regularly contract—HPV and herpes—aren’t an ironclad argument for condoms. Both diseases can be transmitted even if you use condoms, though condoms do prevent a majority of transmissions.

In backing away from condoms, my peers are also backing away from the un-nuanced message we got when we were teens: Namely, if you have unprotected sex, you will get pregnant and die. “I think by the time women hit their mid 20s, they know at least one person who has herpes, at least one person who's had to get warts frozen off of her cervix,” another friend says. “And she understands that these things, while shitty, are not the end of the world.” Even fear of cervical cancer—which is literally the end of the world for those who contract it—doesn’t unroll a lot of condoms because many women my age have received the vaccine Gardasil.

If you’re not convinced you need condoms to stay safe, it’s hard to see why you’d choose them. Though the stereotype is that men are the ones who hate condoms because they’re no fun, studies have shown that more women than men complain about the “physical displeasure of male condoms. [6]” Another friend, call her Erin, who is 31, told me, “Condoms make orgasms difficult, and I'm pretty sure any guy will agree with me there.”

Why not switch to a more pleasing option like the pill or an IUD if you’re in a relationship and hate condoms? Some women don’t find those methods much of an improvement. Erin has gone off hormonal birth control because she found that once she hit 30, the pill decreased her sex drive. She was curious about an IUD, but her gynecologist used a line straight out of Baby Mama, “I just don’t like your uterus”; he thought it was too small for an IUD. Another 32-year-old friend got fitted for a diaphragm. “It looked really old,” she said. And in fact, her doctor admitted the diaphragm had been used before. It was just for sizing and cleaned with bleach, the doctor told her, but my friend wasn’t sold.

No one I talked to wants to get pregnant right now, but here, too, the risk calculus has gotten more complicated than it once was, because the idea no longer seems soul crushing. “I'm just not as terrified of the ‘what if’ as I used to be,” Erin says. An article published last year [7] in the journal Perspectives on Sexual and Reproductive Health quoted a 27-year-old college-educated woman. She’d been “religious” about using condoms, but as a relationship progressed, she “occasionally used withdrawal or nothing at all,” because “sometimes when I was having sex with [my boyfriend], I would just kind of lose my mind a little bit and want to have a baby with him.” But when she discovered she was actually pregnant, she was “horrified, of course,” and had an abortion.

That matches up with another statistic: Almost 80 percent of pregnancies among twentysomething women with some college education are unplanned [8]. And yet efforts to reduce that rate don’t try to understand the contraceptive reality of women I know. The newest one, SexReally, a website aimed at women in their 20s launching this week from the National Campaign to Prevent Teen and Unplanned Pregnancy, follows the typically stale public health script. The site’s main blogger is Laura Sessions-Stepp, who was in her 20s during the Reagan administration and has spent the past decade lambasting the pleasure-based “hook-up” [9] culture. In Stepp’s second blog post on SexReally [10], she writes, “Slowly, the study of true love is making a comeback in college research labs and classrooms, and SexReally will encourage it." Got that, girls? “Research” is going to prove that you should wait to have sex until you’re really in love! Why does SexReally think twentysomethings will go for a message that has struck out mightily with teens?

Withdrawal doesn’t exist in the SexReally universe: A search for the term comes up empty on the site. But considering the new research and the way women in their 20s and 30s are using contraception—a variety of methods depending on the situation—it may be our best bet for preventing more unplanned pregnancies. Jenny Higgins, a co-author of the Guttmacher withdrawal study and a research fellow at Princeton University, thinks about birth control this way: “Barring condom use, or barring abstinence until marriage, let’s take an approach where people wear condoms when they can, pull out when they can’t, and consider oral sex or mutual masturbation when the woman is ovulating.”

Caveat: No one thinks preaching withdrawal to teenagers, who aren’t likely to do it correctly, is a good idea [11]. But as you get older, the chance of success with withdrawal are greater, because as Jenny Higgins points out, “men in the middle of their sexual life-span have more control.” And the stakes of failure are lower. Nobody wants herpes, but it’s far less of a stigma in the wider world than it would be in high school or college. And women are far more able to cope with unplanned pregnancies when they’re in their 20s or 30s than in their teens. Maybe my peers should be a lot more careful. Or maybe they’re being more rational about risk than they get credit for.

Photograph of condom by Keith Brofsky/Getty Images.