Medical Protocol

COITUS INTERRUPTUS

Introduction
Coitus interruptus or withdrawal is one of the oldest methods of birth control and continues to be
used throughout the world to prevent pregnancy.

Failure Rate
Method failure rate for typical users is nineteen percent within the first year of use and four
percent of perfect users will fail in the first year (Hatcher, Trussell, Stewart, Stewart, Kowal,
Guest, Cates, Policar, 1994).

Mechanism of Action
Coitus interruptus prevents fertilization from occurring by preventing the sperm and ova from
uniting. When using withdrawal as a birth control method, a man and a woman proceed with
intercourse until the man is about to ejaculate. The man withdraws his penis and ejaculates away
from the woman's genital area so that sperm are not deposited on the labia, where they could
ascend into the vagina and uterus and cause a pregnancy.

Advantages and Disadvantages

Advantages
It costs nothing, requires no devices, involves no chemicals, causes no medical side effects and is
always available.

Disadvantages
Aside from the risk of not withdrawing in time, the other major disadvantage regarding coitus
interruptus as a contraceptive involves the pre-ejaculatory fluid that appears after the penis
becomes erect; a few drops of semen, containing sperm, may be deposited into the vagina
without the knowledge of either partner. Current literature indicates that it is unlikely that there
is enough sperm in the ejaculatory fluid to cause pregnancy; however, this question remains
unresolved, and therefore, clients and their partners using withdrawal as their birth control
method need to be highly motivated and educated.

If there is more than one act of intercourse, the effectiveness rate in preventing pregnancy further
decreases. Since coitus interruptus is based on the man's self-control, that is, his ability to
withdraw in time, often both partners cannot truly relax and pleasure is compromised. Also there
is no protection from sexually transmitted diseases (STDs) including HIV.

Counseling
Although withdrawal is "better than nothing,” Tapestry Health Systems does not routinely
include it as a viable contraceptive method during counseling sessions.

 TAPESTRY HEALTH SYSTEMS, INC. August 1996

Protection Against STDs and HIV Infection
This visit is an opportunity to discuss prevention of sexually transmitted diseases. Advise clients
that consistent and correct use of latex barriers (dental dams, condoms, gloves) may help prevent
sexually transmitted diseases (STDs). Inform clients that spermicides (foam, cream, jellies, etc.)
have an antibacterial action and so the use of these agents may also provide some protection
against acquiring STDs.

In several clinical studies vaginal use of nonoxynol-9 reduced the incidence of gonorrhea and
chlamydia infection (Pollack and Moore, 1994). No reports indicate that nonoxynol-9 used
alone without latex barriers is effective for preventing sexual transmission of HIV (U.S.
Department of Health and Human Services, 1993). However, by reducing the risk of gonorrhea
and chlamydia it may reduce the risk of HIV infection. Spermicides may cause vaginal irritation
and increase the susceptibility to HIV infection.

References
Hatcher, R., Trussell, J., Stewart, F., Stewart, G., Kowal, I., Guest, F., Cates, W., and Policar, M.
Contraceptive Technology. New York: Irvington Publishers, Inc., 1994.

Po11ack, A., Moore C. (1994). New Issues in Spermicide Use. Contemporary OB/GYN. Special
Issue Technology.

U.S. Department of Health and Human Services (1993). 1993 Sexually transmitted diseases
treatment guidelines. Morbidity and Mortality Weekly Report, 42 (RR-14).

 TAPESTRY HEALTH SYSTEMS, INC. August 1996