I Chose Withdrawal And I Knew What I Was Doing


RH Reality Check is participating in The Latina Week of Action for Reproductive Justice, an effort meant to raise awareness and spur dialogue about unique perspectives of and by Latina’s on reproductive justice. As part of this week, the National Latina Institute for Reproductive Health is hosting a blog carnival, encouraging Latina bloggers to write posts about contraception (our theme) from their perspectives.  Bianca’s article today is one of those piecs.  The week of action runs August 9 to 15th.

Many media outlets and educators will lead us to think that the withdrawal method is not a birth control method at all. When I was being trained as a sexuality educator there was a joke that went around. It went something like this: “Q: What do you call people who use the withdrawal method? A: Parents.” The logic was that there is no protection from STIs or from pregnancy using this method.

Although this is true, as someone who has used the withdrawal method several times, even after having that sexuality education and training, I knew what I was doing. I was not in a relationship where my power was taken away from me because we chose withdrawal, we knew we didn’t want to have children, and we also knew of our STI and HIV status.

We chose withdrawal for several reasons but the main one is this: We wanted to. Now I know several of my friends, followers, and students may be floored at finding this out about me, but it is true and I am not ashamed, if anything I’m proud.

Just because I provide someone with all of their options and support what they choose does not mean I am always already going to choose what someone else may consider the “right” option for myself. This non-judgmental approach to working with people (for me, especially with youth in my community) in the sexuality field is difficult, but it’s something that is essential to the work we do. I know the risks involved with various activities and with partners and make decisions based on (perceived) trust and respect I have with my partnter(s). Judging someone based on their choices is not going to help them or you. Understanding where they are coming from and where they wish to go and what is sustainable for them is useful and often something that many underrepresented communities and individuals rarely receive in their interactions with health care providers, educators, and the like.

So, what was the scenario that led me to make this decision? I was living in the south, just started grad school part 2 in a PhD program. No matter what anyone tells you about doctoral programs, if you don’t have some money saved you WILL be broke, unless your family is independently wealthy. I was living below the poverty line and eligible for food stamps when I was in graduate school. The man I was partnered with was, and still is, amazing. He was a federal police officer, because that’s what some of your main choices are for an over 25-year-old woman of Color living in Washington, DC wanting to date a man of Color with a similar social justice agenda. Our first date was 8 hours long and I knew he was the person I wanted to spend most of my time with (i.e. this to me meant being monogamous) when he called me that night to make sure I got home okay, ignoring all those “rules” of when to call someone you like spending time with (which I have heard is anywhere from 2-6 days!).

He got check ups regularly through his work and had his most recent STI and HIV test results to share with me as did I. My last lover before him was almost two years prior to that time and I had had regular check ups. He was the kind of partner I wish all people had the opportunity to have: generous, patient, honest, and communicated well. He was the first man who asked for my consent verbally and actually said to me: “I think we should kiss each other now, is that okay with you?” And he would joke later in the relationship when we were ready to kiss in other positions or move onto other activities and say “If you keep kissing me I’m going to assume it is okay to do XYZ, is that alright?” and I would consent or we would stop and discuss, but more so I would consent. Because I wanted to.

As I look back on this relationship I realize that I never once asked him for consent. I wonder what this means about me today, where I ask the people I’m interested in kissing, hugging, holding hands with, if they are open to that form of affection. These are difficult conversations and questions to ask. I’ve had and heard my shares of “no” to such queries and it is a sting to the ego, but at least I know what my potential partners are comfortable with and/or where I stand with them and if I should move on.

Our withdrawal conversation was similar to our kissing conversation. We had already discussed sexual health histories, had engaged in some forms of penetrative activities with condom usage, and discussed the challenges and consequences. It was at that time that I chose to talk to him about spermicide. As a police officer I assumed he would know what spermicide is because he dealt with homicides all day long, but he didn’t. It became my opportunity to share with him what I knew. He is not the first partner I’ve had (who is now over 40 years old) who I have shared with what spermicide does. I’ve had at least 3 other partners where that conversation was a part of our birth control discussion.

We sometimes used the spermicide and we enjoyed one another and we checked in and it, to this day, was one of the most enjoyable relationships I’ve had because we communicated with one another and received consent. When he got an offer for his dream job which would take him throughout the Caribbean, enforcing what I consider questionable international drug laws, I knew that was not the type of relationship I wanted and we ended our relationship. However, we have remained in touch and the last time we spoke he was very impressed and even said he was proud of me for making a name for myself in the sexuality field. That felt really good to hear.

Now I really hate it when researchers, sexologists, educators, and they often judge young people, people of Color, working class people and so many others who chose withdrawal or even spermicides alone as their birth control option. For many of us it is one of the safest and only ways possible for us to engage in sexual activity (which may not always be consensual and if you think it is please take a moment to consider the billions of ways consent is not always present for many people) and decrease pregnancy without having a hormonal or latex connection (many people have allergies to latex, as we get older our vaginal canals change as does our vaginal secretions, and a ton of other things many readers can imagine).

Yes, there is discomfort and resistance in discussing withdrawal methods with patients/youth/clients/partners. Why don’t we look at what that resistence is, where it comes from and why that discomfort is there? How have we learned from our feelings of discomfort in the past? Many of us know that if we are sitting in a class or reading a book or experiencing something that makes us uncomfortable it is a good idea to try and pinpoint what it is about that situation that leads to that discomfort. Until we can honestly figure this out for ourselves, our abilities to provide care and support to communities may not be as helpful as we hope.

I’ll be writing more about birth control for the Latina Week Of Action for Reproductive Justice also at VivirLatino and on my Media Justice column at Amplify.

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

Follow Bianca I. Laureano on twitter: @latinosexuality

  • oodlenoodle

    I can’t say I agree. I think it’s great that withdrawal worked for the author, but for the massive majority, it doesn’t work–and for that reason, withdrawal needs to stop being touted as a “birth control method.”

     

    Also, they do make condoms out of material other than latex…polyurethane, polyisoprene, and likely more being tested and developed (lambskin doesn’t protect against STIs/HIV so most medical professionals do not reccommend it). Latex allergies are NOT an excuse for having unsafe sex.

  • amanda-marcotte

    Characterize my post as “judging”. I would characterize it as being wary of attempts to normalize withdrawal at the expense of promoting better access to more effective forms of contraception.

    Withdrawal is a fine method for people who a) are tested, as you were and b) are willing to accept a higher chance of getting pregnant. Many people are unwilling to accept that higher chance, and we shouldn’t sneer at them for it. Particularly as the people you mention of lower incomes have fewer resources to deal with an unintended pregnancy, it seems troublesome to suggest that they shouldn’t be concerned about adopting a method that has a much higher risk of pregnancy.

  • saltyc

    Withdrawal works, especially when people know what they are doing.

     It’s not about the man withdrawing right before he comes, his penis should be out long before he’s climaxing. The way I practice it, Penis-in-Vagina is not the main course but one of many fun things to do leading up to orgasm. I don’t come during PIV sex anyway, and also it makes the guy’s climax that much more dramatic when it’s center stage and visible.

    True it doesn’t prevent STD’s though anything carried in semen will not be in there to cause trouble, but niether do implants, IUD’s, hormones, etc.

    Plus, you know that if the semen didn’t get in, you won’t get pregnant. That’s according to research I read that I can look up again if anyone needs it, that sperm is not found in pre-ejaculate.

    That means that, you know immediately after coitus whether or not the method failed. Unlike hormonal methods or devices hidden in the woman’s body, which you won’t know if it really worked til later.

    So, if the semen got in the vagina, you’ll know to take plan B right away.

    People who use it & know what they’re doing aren’t accepting a higher rate of pregnancy, they’re using a method that works very well for them, which makes sex more creative, is cheap and always accessible, and has few side-effects.

  • arekushieru

    Well, someone I knew got pregnant, and they had used the exact same withdrawal method as you described, Salty so, yes, please give me the link so I can point it out to my friend and see if, maybe, there were differences, after all!  :)

  • amy0440

    I think it is irresponsible to teach someone that using withdrawal is an effective birth control method (regardless of placing judgement on their method of preference). Others have already raised the point that you need to do withdrawal correctly for it to be as effective as the author claims & many guys (sorry) don’t have that kind of self control, especially sexually active teens.  I think that the just and fair thing to do is to give a person all the accurate information they need to make a decision for themselves including information on success rates and taking in account each person’s individual needs. If you’re going to write an article promoting the usage of withdrawal I’d expect to see one promoting the usage of ParaGard. I’ve heard that joke about what do you call people who use the withdrawal method and there is some truth to it (obviously) but also I have another response: they’re ambivalent to pregnancy or they are not assessing risk correctly. that is all.

  • rachel

    Thanks, Bianca, for sharing your story and insights. The science suggests that withdrawal is only slightly less effective than condoms, and it does substantially reduce the risk of pregnancy. So you are right that we should be discussing it. (The link below is to a commentary on this topic that was published a little over a year ago)

    http://www.guttmacher.org/pubs/journals/reprints/Contraception79-407-410.pdf

     

     

  • saltyc

    I talk to women weekly who unintentionally got pregnant and the methods they use run the entire gamut of contraception, including implants, pills, condoms, devices, etc. 

     Did your friend avoid semen in the vagina? It has been 100% effective with me, so long as the semen did not get in the vagina, and that’s not second-hand info.

    This is a link to a study that found no sperm in pre-ejaculate

    http://cat.inist.fr/?aModele=afficheN&cpsidt=14705369

  • ack

    Like Natural Family Planning, the effectiveness of the withdrawal method is going to depend entirely on the people using it. If you’re abstaining from sex two weeks before your expected period, you’re not using NFP. It’s a lot more complicated than that. I’ve never used it, but everything I’ve read about it describes intimate knowledge not only of your cycle, but of the reproductive system in general. Most people who think they’re using it aren’t.

     

    Similarly, I could see how two people in a relationship like the one described by the OP could make withdrawal work. But common use of withdrawal isn’t going to garner those results. I worry about promoting it to people who don’t have the additional education to use it correctly by taking other precautions like STI testing and spermicide use, and don’t have access to EC. It’s a little troubling to see headlines about the effectiveness of withdrawal and think about the effect a single sentence fragment could have on people.

  • grayduck

    “Why don’t we look at what that resistence is, where it comes from and why that discomfort is there?”

     

    The discomfort comes from knowing that highly scientific, large-sample, repeated studies have shown that it has an absurdly high failure rate. The method is 540 times as likely to fail as Implanon. It may be fine if you want eight children (the failure rate multiplied by the number of years that the typical woman is sexually active, fertile, and trying to avoid pregnancy) rather than twenty, but most people are not interested in that level of risk.

     

    http://www.contraceptivetechnology.org/table.html

  • grayduck

    Amanda Marcotte, RH Reality Check on August 11, 2010 – 1:23pm: ” I would characterize it as being wary of attempts to normalize withdrawal at the expense of promoting better access to more effective forms of contraception.”

     

    Thank you; those are my sentiments too.

  • grayduck

    SaltyC on August 11, 2010 – 2:34pm: “People who use it & know what they’re doing aren’t accepting a higher rate of pregnancy, they’re using a method that works very well for them…”

     

    Can you cite scientific research that supports this claim?

     

  • grayduck

    SaltyC on August 11, 2010 – 3:22pm: “This is a link to a study that found no sperm in pre-ejaculate…”

     

    That was a single study done seven years ago with just “four normal healthy volunteers.” The method used by the study has not, as far as I can see, been deemed reliable by any experts or studies. Moreover, both experts and other studies have disputed the results.

     

    Mayo Clinic: “Pre-ejaculation fluid may contain sperm, which means that a woman can get pregnant even when ejaculation doesn’t occur within the vagina.”

     

    http://www.mayoclinic.com/health/birth-control/AN00197

     

    Planned Parenthood: “Even if a man pulls out in time, pregnancy can still happen. Some experts believe that pre-ejaculate, or pre-cum, can pick up enough sperm left in the urethra from a previous ejaculation to cause pregnancy.”

     

    http://www.plannedparenthood.org/health-topics/birth-control/withdrawal-pull-out-method-4218.htm

     

    “…most pre ejaculate samples did not contain any sperm…”

     

    http://www.ncbi.nlm.nih.gov/pubmed/12286905

  • grayduck

    Rachel on August 11, 2010 – 3:13pm: “…withdrawal is only slightly less effective than condoms…”

     

    But condoms also have a very high failure rate, so this comparison does not justify promoting it over more effective methods like Implanon.

     

  • sweetchild92

    ‘That means that, you know immediately after coitus whether or not the method failed.’

    Women who have become pregnant due to this method’s failure, and did not know until a missed period, may feel otherwise.

  • sweetchild92

    Just because a method has been 100% for you means little when it comes to other women, though.

    Some women will become pregnant while using hormonal birth control, whether that’s user failure, or even more rarely, a fluke. But other women will use hormonal bc their entire reproductive years and never face an unintended pregnancy.

  • sweetchild92

    A high failure rate…? Of 2% with perfect use?

  • kismet

    Bianca, thank you for posting this story.  I’m always amazed at the ease with which you tell extremely personal stories and share them willingly with the world, knowing that even when it is difficult to discuss certain topics, the greatest weapon the system of heteropatriachy wields against us is ignorance and silence. 

    That said, I was surprised to drop by the site and find such a narrow-minded comment stream.  I think I understand it–the issue that seems to confound so many readers is whether or not spermicide is an effective (read: stops pregnancy) form of birth control.  I don’t know the stats so I won’t comment there but I actually think that’s the least least and one more least interesting thing about Bianca’s post! 

    Considering one of the goals of women’s health, reproductive health and related movements is to EMPOWER women to make their own choices in regards to their bodies, I was really gratified to hear about how Bianca did that–and then demanded that individuals and organizations be held accountable and do the same without putting value judgements on different forms of birth control or different women’s (rich or poor, old or young, married or unmarried, gay or straight or anywhere on the spectrum) choices on the same.  Her point that not all women (non-white, non-Western, poor, to push B.’s emphasis) have choice in the mainstream, second wave feminist sense of the word is really important to remember and if the only way that she is able to control her reproductive choices is to use spermicide then we need to find ways to work with her–not convince her she isnt’ doing enough, she’s wrong (read: she’s bad, etc. something that, if she’s in any kind of controlling relationship from father figures to partners, she may hear everyday or PROCESS in that direction). 

     

    In any case, there is much more to be said here but thanks Bianca for being so open and bringing us into your world.  besos mujer….

  • maxwell

    @GrayDuck and others talking about irresponsibility – i think you need to check your logic.  yes implanon is more effective in clinical trials and epidemiological research than withdrawl or condoms, but so what?  you know what’s even more effective?  abstinence.  and you see how well that worked when the feds promoted it as the ABSOLUTE BEST METHOD FOR EVERYONE.  cause methods don’t work the same for everyone and epi data and clinical trials don’t pick up on the complications that make something like say, withdrawl more appropriate for a couple than condoms or an IUD.  and i’m not talking about latex alergies.  i’m talking about a whole host of things from what methods are economically available to how much trust and sexual health knowledge there is in the relationship.  all things Bianca explained pretty well. 

     

    i think the bottom line is that you definitely have to give people all the info–and i can personally testify that Bianca is an A++ sex educator and does exactly that–and then you gotta trust them to make the decisions that are right for their life and support them.  NOT dictate decisions to them.  and as another person who withrawl has worked successfully for (over a long period of time), i think it’s about time we recognized it as another tool in our sexual health toolbox.

  • saltyc

    One thing I mentioned before but want to repeat, is that withdrawal, or really making sure semen ends up somewhere not the vagina, method, is especially effective as a secondary form of protection. So there’s no reason not to use it if you are already using another form. I really would promote that, over my method of its primary place which worked for me but probably not for everyone.

    So don’t dismiss it because that could be what saves you when the other method fails.

  • grayduck

    sweetchild92 on August 12, 2010 – 6:01am: “A high failure rate…? Of 2% with perfect use?”

     

    The perfect-use rate is based on two assumptions that apply to very few women.

     

    First, it assumes that the user can use it as correctly as someone in a laboratory situation. So, for example, it assumes that a woman will never be raped by a man who refuses to use a condom while raping her. Does that sound like a reasonable assumption for most women?

     

    The second assumption is that a woman will only need contraception for a single year of her life. That duration of use is not typical.  “The typical American woman has intercourse for the first time at age 17 and reaches menopause at age 51. If she wants only two children, as most American women do, she will spend three decades being sexually active but trying to avoid unintended pregnancy.”

     

    http://www.guttmacher.org/pubs/tgr/06/5/gr060507.html

     

    Relaxing those two assumptions yields a very different failure rate- approximately 99.7 percent. That rate is derived by extrapolating the 17.4 percent typical-use failure rate across thirty years. (1-(1-0.174)^30)


  • missturman

    Thank you for posting this Bianca and hopefully someone who needs this information will read it, digest it, and get what they truly need from it instead of being judgmental. Nowhere do I see you promoting withdrawal or even sex for that matter. What I read was an honest, frank portrayal of a time/relationship where you and your partner were educated, communicating, and choosing this method. Let’s face it, there is nothing ever 100% safe besides not having sex at all, but folks do need to be aware of their options, regardless of the circumstances. Again, thank you for this post.

  • grayduck

    maxwell on August 12, 2010 – 12:07pm: “yes implanon is more effective in clinical trials and epidemiological research than withdrawl or condoms, but so what?”

     

    So people should not be misled into thinking that all methods are even remotely equal.

     

    you know what’s even more effective?  abstinence.

     

    Prove it.

     

    …methods don’t work the same for everyone and epi data and clinical trials don’t pick up on the complications that make something like say, withdrawl more appropriate for a couple than condoms or an IUD.

     

    This article is not customized to a particular set of users. Rather, it is being broadcast to all kinds of people.

     

    …you definitely have to give people all the info…

     

    But that is exactly my point. RH Reality Check has broadcasted articles about ineffective contraceptive methods like withdrawal, spermicides, condoms, and pills but has never provided any information about Implanon. Why is RH Reality Check refusing to give people all the relevant information? Why are they not providing women and men with information about Implanon?

     

  • crowepps

    But in the interests of full disclosure here are some reasons why this new way of delivering hormonal birth control (very similiar to Norplant) does NOT work for everybody:

    Side Effects
    The most common side effects reported during studies of Implanon included:

     

    • Weight gain
    • Acne
    • Menstrual disturbances
    • Depression
    • Mood swings
    • Headaches

     

    In addition to the side effects listed above, common side effects reported in clinical trials included:

     

    • Breast tenderness
    • Abdominal or period pain
    • Viral infections (i.e. sore throat, cold)
    • Vaginitis
    • Anxiety
    • Nausea
    • Dizziness
    • Back pain
    • Change in libido
    • Pain at site of injection
    • Pain

     

    Menstrual disturbances were quite a nuisance for many women and resulted in one in 10 women discontinuing the use of Implanon during studies. A variety of menstrual problems were experienced by women using Implanon, such as amenorrhea, spotting, irregular periods or prolonged bleeding. In fact, menstrual problems are so common, manufacturers of Implanon write in their patient information leaflet that women should anticipate their periods becoming irregular and unpredictable while they are using this contraceptive. In other words, unlike other side effects, menstrual disturbances do not eventually subside.

    Other, rare side effects were also reported during studies on Implanon and included:

     

    • Increased hair growth on face and body
    • Vision problems and irritation in contact lens wearers
    • Darkening spots of skin, mainly affecting the face

     

    Complications During Insertion and Removal
    Some minor complications may occur when insertion of Implanon takes places. This can include some tenderness, swelling, redness and bruising of the implant area. In rare instances, the implant may fail to be inserted, either because the rod has fallen out of the applicator or because it was inserted improperly. It is also possible for the body to expel the implant, but again this is rare.

    Other problems that may occur when Implanon is inserted or removed include:

     

    • Scarring
    • Formation of scar tissue around the implant
    • Infection
    • Need for surgical removal in hospital (rare)

     

    Being unable to feel the implant, having a broken or damaged implant, experiencing troubles locating the implant or having an implant that has migrated slightly contributed to 1.7% of study participants having greater difficulty when their doctor removed their implant.

    http://www.epigee.org/guide/implanon.html

  • arekushieru

    Thanks!  It’s much appreciated!  And that’s a good question….  Hmmm….

  • arekushieru

    Or vice versa….  :D

  • sweetchild92

    What on earth does this have to do with rape? I’m disucssing women who use it with their cis male partners/when pregnancy can happen. Not what can happen if they’re raped, which research does not take into account.

     

    I know about this research, thanks. You mentioned the high failure rate of condoms. Well, too bad, because the perfect use-no matter what the factors are, show them to be incredibly effective. Even the typical use rate is far more effective than nothing at all.

  • sweetchild92

    Lol @ proving abstinence’s effectiveness. Just stop. People who choose abstinence, because intercourse and sex are not the best option for them, will not become pregnant. And don’t bring in your “well she can be raped” mantra. No matter how effective implanon is, none of these methods can top not putting a penis near a vagina.

  • sweetchild92

    We could also bring up the unavailability of this method due to cost and availability of a trained provider, but from experience, that apparently doesn’t count with grayduck.

  • beenthere72

    Are you an implanon salesman or something?  WTH.

     

    I am thankful that my husband is snipped so I don’t have  to worry about this stuff anymore, but I tried other forms of birth control at some point in my life besides the pill, like the depo shot, and I spotted for 2 months straight.  It’s not fun trying something new not knowing how it will affect you.  

  • halli620

    This is a very odd article, and I’m not even sure what your point is – and I’m someone who’s used the withdrawal method for nearly a decade already and I “know what I’m doing.” I THINK that the article is in favor of accepting the withdrawal method as valid choice when you’re in a monogamous relationship with proper testing and trust. I’d agree with that. However, the whole tone of the article, assuming that other people won’t agree with you, puts an odd slant on the issue as if you not only feel defensive about it, but feel that you should feel defensive about it. I’d avoid such confusing approaches in the future. Although the withdrawal method does not offer protection against diseases, there is virtually no risk of pregnancy if the man is knowledgable enough about his own body to know when to withdraw (ie. younger men may not have as much control over it), and the very small risk of semen remaining from a recent ejaculation is lessened even more by urinating and by any time elapsed between two sessions. Just state the facts (no protection against diseases, man has to know his own body), and stay away from convoluted defenses that do nothing but sound defensive.

  • rikiam

    “For many of us it is one of the safest and only ways possible for us to engage in sexual activity (which may not always be consensual and if you think it is please take a moment to consider the billions of ways consent is not always present for many people)…”

     

    If consent is not an option, why promote withdrawal as birth control? Your story shows that intimate, consistent partner communication and respect are necessary to use withdrawal effectively. Let me go out on a limb here and say that these necessities are not present in non-consensual sexual relationships, and therefore withdrawal is a ridiculous and disingenuous option for women in such relationships. If a guy doesn’t care about whether you consent to sex in the first place, what makes you think he would prevent his own climax just to avoid your pregnancy or an STI?

     

    Withdrawal worked for you and your partner in a respectful, loving, communicative relationship. That’s great. You want all women to have options in sexual relationships – ALL of us in repro work want that.  But not all women are blessed as you were, and you don’t lose your repro rights cred just because your method isn’t available to all women. Don’t try and paint it like it is. In fact, I can’t help but see throwing that above quote into your blog as an exercise in assauging your guilt at the “privilege” (of withdrawal) you experienced in this past, blessed relationship.

  • arekushieru

    I think the number of replies disagreeing with the method might point to why she feels defensive…?  I don’t agree with the withdrawal method, because, just as it is difficult to know when a woman is fertile, because it is inconsistent, it sounds like it’s very difficult for a man ‘to know his body’, because that, too, sounds like it can be inconsistent.  However, I have no problem with someone choosing this method for themselves but many do have a problem with it, apparently.

  • grayduck

    How is withdrawal not a daring form of abstinence? Abstinence means not engaging in activities that will result in pregnancy. Done perfectly, withdrawal accomplishes just that. How is “making sure semen ends up somewhere not the vagina” fundamentally any different from kissing or holding hands?