I recently gave my professional opinion for an article about birth control that specifically relates to the use of the withdrawal method (AKA the pull out method or, if you’re nerdy, coitus interruptus). The article, written by Brendan Jay Sullivan, has a pro-pull out bent and suggests it might be the preferred form of birth control for millennials. Since I can talk about sexual health for days, he narrowed the focus and asked specific questions. The full list of questions and my answers can be read in the Mademan.com post. Many are straight forward but, given the limited number of words and the nature of the article, there are some points I’d like to stress further.
First, I would never recommend the withdrawal method as a primary choice of birth control. Especially NOT for millennials. Science has shown that young men’s brains aren’t fully developed until age 25 (or later), they can’t help themselves from engaging in impulsive or risky behavior, and don’t reach maturity until well into their 30s (or 40s). I would NOT advise that anyone leave the timing of withdrawal to a young man especially if there is alcohol involved (like the colorful example used in the article). Drunk or not drunk, premature ejaculation occurring in 30% of healthy men makes the proper exit timing an uncertain event.
I would also like to be clear that the withdrawal method leaves participants wide open for infection. Contracting an STI (sexually transmitted infection) is a potential consequence of using the pull out method of birth control. This, of course, is another reason why I don’t recommend it. Especially for millennials who, statistically, make some questionable health-related choices and have the highest incidence of chlamydia and gonorrhea.
To be clear, the Mademan.com article was written about a method of pregnancy prevention–not STIs. But, as a medical professional, it is hard to have a conversation about one without the other. That is why I counsel individual patients based on their unique concerns. We have conversations and weigh the pros and cons based on many factors. There is no blanket statement about birth control and STI prevention that is right for everyone. Except maybe condoms.
I hear two common arguments from millennials about condom use. The first is from educated young women who say they are insulted if a man attempts sex without one. They consider it highly disrespectful and I am completely onboard with this ideology. The other is from professional guys who are unfazed by STI risks. These men did not live through the AIDS era and have no fear of bacterial infections that are easily treated with antibiotics. In fact, the de-stigmatizing efforts of herpes have worked so well in some cases that I’ve heard, “Everyone’s got it. If I don’t already have it, I’m gonna get it eventually.” An MBA educated male millennial in NYC asked me, “What’s out there that’s really gonna f*ck me up? I want a wife some day and I don’t want it to affect her.” And who says chivalry is dead?
But seriously, consider syphilis. It’s making a strong comeback in the men-having-sex-with-men community and it is ignorant to think that it isn’t going to pop over to the men-having-sex-with-women community in a matter of time. Syphilis is a solid argument for condom use.
Despite syphilis and the risk of being anti-feminist, one of my favorite male millennial friends, who is a total mensch with the ladies, says he doesn’t like the way condoms feel. He grumbles that, “Condoms don’t feel like the real thing. Not as warm, wet, or inviting,” and would prefer not to use them. On the contrary, when I asked a 42 year old sexually active man who’s been with over 80 women since 1987, he said, “Condoms aren’t what they use to be. They come in bigger sizes and are more comfortable. Now they are thin and you can feel things. It isn’t like cramming your dick in a garden hose anymore.” If the saying is true, wisdom comes with age.
Obviously there are many perceptions and attitudes regarding condom use, infection prevention, and birth control. Not all were explored in Brendan Sullivan’s article, but I believe the point was to start a conversation. Hopefully you’ll continue by talking with your primary care provider or licensed sexual health professional along with your intimate partner. Or partners. And while you’re figuring out your best method, be safe.
Some additional reading: My encounter with antibiotic resistant chlamydia OUTSIDE the clinic.