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Letter to the Editor

Coitus Interruptus Is Not Contraception

Doherty, Irene A. PhD, MPH; Stuart, Gretchen S. MD, MPHTM, FACOG

Author Information
Sexually Transmitted Diseases: April 2011 - Volume 38 - Issue 4 - p 356
doi: 10.1097/OLQ.0b013e3181bc0628
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To the Editor:

In the article by Sznitman et al.,1 the authors suggest that because 60% of the adolescents in their study reported use of coitus interruptus, “sexual educators need to honestly acknowledge withdrawal can prevent pregnancy.”

The probability of coitus interruptus failure is estimated to be 18.8% during the first 12 months of use.2 Furthermore, an estimated 27% of women users of coitus interruptus have an unintended pregnancy during the first year of use.3

We assert that coitus interruptus should never be presented to adolescents, or any person, as a valid method of contraception. The American College of Obstetrics and Gynecology, Planned Parenthood Federation of America, the Office of Women's Health (in the US Dept of Health and Human Services) (available at:, accessed July 10, 2009) and US Centers for Disease Control and Prevention (available at:, accessed July 10, 2009) do not include coitus interruptus in their lists of contraceptive methods. Planned Parenthood, in fact, strongly recommends to adolescents not to practice coitus interruptus because of their inexperience (available at:, accessed July 10, 2009).

Sznitman et al.1 rightly advocate for condom promotion as respondents who reported inconsistent condom use and withdrawal were 2.22 (95%CI [1.06, 4.66]) times as likely to have a sexually transmitted infection as consistent condom users. Condoms alone, however, are not a highly effective method for preventing pregnancy, especially among adolescents; an estimated 15% to 17% of condom users will become pregnant during the first year of use.2,4

Up to 7.5% of adolescent girls, ages 15 to 19, become pregnant in 1 year5; about half of them give birth, one-third have abortions, and the remainder miscarry (or have stillbirths).5 Furthermore, between 2005 and 2007, the teen birth rate increased by 5% and, in 2007, 4.2% of adolescents gave birth.6

These statistics signal the need for renewed action of promoting dual method use of condoms and contraceptive methods.7,8 Because adolescents experience elevated rates of sexually transmitted infections and unintended pregnancy, health practitioners and educators must provide a holistic approach to protecting the reproductive health of adolescents.

Irene A. Doherty, PhD, MPH

Department of Medicine

Division of Infectious Diseases

School of Medicine University of North Carolina

Chapel Hill, NC

Gretchen S. Stuart, MD, MPHTM, FACOG

Department of Obstetrics and Gynecology

School of Medicine University of North Carolina

Chapel Hill, NC


1. Sznitman SR, Romer D, Brown LK, et al. Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among African-American adolescents. Sex Transm Dis 2009;36:218–220.
2. Kost K, Singh S, Vaughan B, et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008;77:10–21.
3. Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception 2008;77:1–5.
4. Trussell J. Contraceptive efficacy. In: Hatcher R, Trussell J, Stewart F, Nelson A, Cates W, Guest F, eds. Contraceptive Technology: Nineteenth Revised Edition. New York, NY: Ardent Media; 2008.
5. US Teenage Pregnancy Statistics National and State Trends and Trends by Race and Ethnicity. New York, NY: Guttmacher Institute; 2006.
6. Hamilton B, Martin J, Ventura S. Births: Preliminary data for 2007. Natl Vital Stat Rep 2009;57.
7. Cates W Jr. Contraception, unintended pregnancies, and sexually transmitted diseases: Why isn't a simple solution possible? Am J Epidemiol 1996;143:311–318.
8. Cates W Jr, Steiner MJ. Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach? Sex Transm Dis 2002;29:168–174.
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