Earlier this year I attended a bachelorette party for one of my closest friends. As part of her special weekend, I organized a little lingerie shower for her. The bride is not your typical girly-girl by any means. She’s a one-of-a-kind gal. She loves football and had a childhood obsession with space so deep that it inspired the theme for the entire weekend: His Dick Was Out of This World. We all stumbled around Austin’s 6th street dressed as aliens or astronauts while the bride donned a very authentic Astronaut helmet adorned with a veil. The gifts for the lingerie shower reflected the bride’s authenticity. They ranged from panties representing her favorite NFL team, lacy teddies to one grandma-chic house dress.
The gift that made me cackle the hardest was a 100% Egyptian cotton plush hand towel. The gift giver precariously folded the towel in a way that required the bride to slowly reveal its message letter by letter. Once fully removed from the wrapping the black ornate embroidery eloquently spelled out “cum rag”. I howled as I thought to myself “Well, I guess everyone really is doing it.”
The Pull Out Method
As a Nurse Practitioner in Women’s Health, I have the “what form of birth control do you use” conversation approximately fifteen times a day. The most common answer is birth control pills and very often a sheepish “nothing” comes tumbling out. Like a dirty little secret. However, what I’ve discovered upon further interview is that “nothing” is most often something…the pull-out method.
Medically speaking, if you have sex with the pull-out method and nothing else, we consider that unprotected sex. Although this is not considered protection in the eyes of medicine, why aren’t more people living a Thirteen Kids and Counting type lifestyle? When I say that a lot of people report this as their chosen form of birth control, I mean a lot. The national research is varied on the actual use of the pull-out method because often (as in my personal survey) couples consider this to be “nothing”. The effectiveness is also questioned by medical professionals because of such varying results in real world studies.
However, the consensus is that the pull-out method can be as accurate as 4 out of 100 couples with perfect use. This means that after one year of using the pull-out method 4 couples will get pregnant. That’s pretty damn good considering in comparison, out of every 100 couples that use condoms for one year 2 couples will get pregnant per The National Institute of Health. Now I don’t know what kind of Mean Girls-Esque Sex Ed class you had but I was told the pull-out method works practically never.
I have two theories as to why the pull-out method never got the respect it deserves. First, the STD rates were the biggest concern of the medical community. In theory, if you start telling people the pull-out method works, infection rates would skyrocket. In the 1970’s the number of cases of gonorrhea hit an all-time high of over one million cases per year and it continued to hover around there well into the 80’s. In 1990 there was a change in the approach to sexual health and sex education in the school system thanks to The National Guidelines Task force. They developed the smex ed guidelines we’ve come to know and love (read hate) for teaching kids in high school about sexual health which becomes our foundation of sexual health. It hasn’t really changed much since:
Although not all inclusive, it was effective considering the cases of gonorrhea steadily declined over the next twenty years. However, we are now in a new upswing of cases. Whether that is due to lack of condom use, increased misinformation from unreliable social media sources or the evil pull-out method, that has yet to be determined by the researchers hired to decide those things.
The STD heavy education theory ties into my second theory: gatekeeping in women’s health. There is a lot of gatekeeping when it comes to women’s health in general but particularly in sexual health. Society, the women’s health sector, and everyone but the woman in question has taken it upon themselves to decide who should or shouldn’t get pregnant, when they should and how they should get pregnant. Birth control pills became the answer to every OBGYN problem because it killed two birds with one stone: “fix” your problem and stop you from getting pregnant. Although it can be a great option for some, it isn’t the birth control answer for everyone which is what piqued my interest in non-hormone options and the pull-out method in the first place.
Birth Control: A Women’s Only Problem
Birth control has been historically a “women’s issue”. When you think of birth control, most people automatically think of birth control pills and IUDs a.k.a: interventions for women. Yet another responsibility society expects women to handle quietly, perfectly and without complaint. Emphasis on without complaint.
Birth control pills make you feel like you’re losing your mind? Well, at least you’re not pregnant. Your IUD migrated into your uterine wall and now you need surgery? Well, at least you’re not pregnant. You forgot to take your pill because of the other ten million responsibilities you have in a day and now you’re pregnant? Well, shame on YOU woman! I call bullshit.
There are other options out there that don’t require you to completely disrupt your endocrine system with synthetic hormones, but we don’t teach those options regularly. Did your sex education teacher teach you about fertile awareness? Phexxi? Spermicide? I bet not. Someone, somewhere decided to edit the information being provided to you for a multitude of reasons including personal bias. I operate on this wild and outlandish idea that I trust you with your own body.
Fertile awareness
Fertile Awareness is essentially the female version of the pullout method. You track your cycles, changes in your mood and body to determine your fertile window. You then avoid sex on these days or use a second form of birth control: condoms, Phexxi, spermicide and pull-out.
A woman can only get pregnant approximately seven days out of the month: 5 days before ovulation, the day she ovulates and 24 hours after the egg is released. Fertile Myrtle isn’t as fertile as you thought, eh? Again, sex ed had us believing you will get pregnant every hour of every day as a teenager. The truth is no matter how fertile you are…you still get one shot every month. You can see below how the Flo app tracks the fertile days of your cycle. Flo gives you a few more fertile days each month because of the possibility of error in an app that’s supposed to learn your vagina through an algorithm.
It is my favorite thing to teach my coaching clients because it is so effective, works in harmony with the natural flow of your body and really helps women to connect to their bodies in ways other methods of pregnancy prevention don’t. Two birds, one stone: improve your cycle and prevent pregnancy. I love that for you.
Phexxi
Phexxi can be used with or without the fertile awareness method. This is a prescription vaginal gel that needs to be inserted one hour before sexy time and works for a full 24 hours. It’s vaginal Ph safe and keeps your vagina happier than over the counter spermicides. Phexxi is only available through prescription so ask your OB/GYN if you think it could be a good option for you.
The Pull-Out method
is a male’s contribution to pregnancy prevention, and I personally believe this is the unconscious (perhaps conscious) basis for the gatekeeping of true statistics. It’s boy math. An egg minus sperm doesn’t equal a baby. However, this may impede men from getting the most possible pleasure from sex and how dare we as women take any ounce of sexual pleasure from a man.* Insert eye roll*.
I am of the opinion that the pull-out method was put to the wayside socially because of the underlying subconscious belief that the man’s pleasure is the most important part of sex. Medically, it was ignored because of the increasing STD numbers. The health department had priorities.
I like to refer to the pull-out method as “responsible ejaculation” because that’s what it is. It’s a non-hormonal option that shifts more of the responsibility to the men participating in the dance-with-no-pants. I emphasize the word option.
I view my role as a provider in women’s health and hormone health coach as someone who is here to provide you with the risks and benefits of all the options available to you. You get to choose which option or combination of options is right for you. A safe sex a la carte menu if you will.
For myself, I personally like the #4 combo meal off that menu: responsible ejaculation and fertile awareness. When these two methods are used together it’s… *chef’s kisses*. It is a hormone free and exceptionally effective option. The woman is removing her egg from the equation while the man is keeping his sperm to himself. No egg, no sperm equals no baby. This method of birth control can be up to 99% effective.
The truth about the pull-out method is that it is just as safe and effective as other forms of birth control when you consider that all available forms of birth control have varying effectiveness scales based on human performance.
The non-hormonal options have even greater variations in their effectiveness however they are often the only options for some couples. Every couple must take the information available and assess their risk tolerance.
It reminds me of when my husband and I met with a financial advisor. The first question they asked is “what is your risk tolerance when it comes to this money?” For some couples, they have a pull-out method risk tolerance meaning that a baby wouldn’t be the end of the world. For some couples they have a very low risk tolerance and there is absolutely no room for error: we must not procreate under any circumstances.
All in all, the pull-out method works if you work it. A beautifully embroidered cum rag in your nightstand drawer can be just as effective as that Trojan sitting in your wallet for the last fifteen years. Assess your risk tolerance and ejaculate responsibly my friends.
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