Withdrawal Alternative?


Dr. Kate,

I’m 32 and last year ended a 10-year relationship with a guy, and when I did so, ended a 14-year relationship with hormonal birth control. It’s been pretty cool watching and feeling my body seek out its own natural rhythms after all these years of pills and patches and rings telling it what to do when! However, I’m now in another monogamous relationship and have been reminded that I really am not a fan of condoms, and am thinking about other means of birth control again.

My partner has great control in terms of withdrawing in time, but I still don’t like the general odds of that method and don’t want to rely on that alone. I don’t really want to deal with diaphragms or sponges because they’re super-inconvenient and require messy spermicide. So…is it back to HBC for me? It seems so unnatural and not-wise to the secret health-nut/hippie/moon-goddess in me, even though my last form of protection, the NuvaRing, gave me no overt problems whatsoever.


Dear Womb-Watcher,

Withdrawal as a method of birth control is certainly better than no method at all. It’s free to use, has no side effects, and is always available. I have had patients use withdrawal as their only method quite successfully for many years. But using the “pulling out” method does require incredible control on the part of your partner. Some women feel anxiety about the end of intercourse, not being sure if their partner is going to withdraw completely before they come. And the effectiveness rate is not great—of every 100 women who use withdrawal as their primary contraception, 22 will become pregnant every year. So while withdrawal is better than crossing your fingers, there are much better methods out there.

withdrawal alternatives

The diaphragm has its believers, among women who don’t want to or can’t use hormonal methods. But it’s waning in popularity—I just did my first diaphragm fitting for a patient in the past 3 years! And it’s hard to get a diaphragm these days. Your doctor likely has to order it direct from the company that manufactures it, and you’ll have to go back to the office to pick it up. I’m more of a fan of birth control you can use and forget about…hard to forget about it when you’re in the bathroom filling up your diaphragm with N9 spermicide while he’s waiting for you in bed!

There’s no down-side of long-term use of hormonal birth control. And the hormonal methods are more effective than the barrier methods like condoms and diaphragms. But if you don’t want to go back to the hormone hotel, I think a copper IUD is just the thing. You get the awesome protection against pregnancy of the pills and rings, but it’s totally hormone-free.

Even though a copper IUD can last for 10-12 years, it doesn’t have to. I tell my patients that if they want to wait at least a year to try for pregnancy, an IUD is worth it, in terms of cost, fuss, and worry.  So unless you’re looking at trying to conceive in early 2020, I’d go for an IUD—it will make both your uterus and your inner moon-goddess happy.

Dr. Kate