Withdrawal attitudes and experiences: A qualitative perspective among young urban adults

Withdrawal is a widely used contraceptive technique that has received little attention in reproductive healthcare research and practice. Given this gap, we explored the use of withdrawal as part of a mixed methods contraceptive study that included 95 ethnically diverse males and females aged 18-25 years. While results showed that withdrawal was a popular contraceptive technique, opinions on its effectiveness were mixed. Some (especially women) expressed anxiety concerning pregnancy risk due to perceived ineffectiveness of withdrawal and concerns about their own, or their partners, capacity to consistently withdraw prior to ejaculation. In contrast, other participants considered withdrawal to be an effective pregnancy prevention technique and expressed confidence in their own/partners' capacity to use withdrawal correctly and consistently. Reasons given for the use of withdrawal included convenience, dissatisfaction with hormonal contraceptives, and being more pleasurable than condoms. Withdrawal was described as an expected alternative to condoms in both casual and long-term relationships, as a secondary method used in conjunction with hormonal contraceptives or condoms, and as a back up strategy for a primary method (e.g., condoms were unavailable, inconsistent pill use). Findings suggest that healthcare provider-initiated discussions about withdrawal could result in greater insight into patient pregnancy/STD risk behaviors and more informed prevention counseling messages.