Is The Pull-Out Method The New Pill?

Why now?

To understand why the pull-out method is back in the conversation, you have to look beyond the method itself and towards the wider cultural shift happening around it. The world over, women are reassessing their relationship with hormonal contraception – and what once felt like a given now feels, for many, like a trade-off they’re no longer willing to accept. “Hormonal contraception is not consequence-free,” says Emma Richardson-Gerrard, founder of The Knude Society. “We’ve been popping the pill for the last 60 years without really questioning what it does to women's bodies. The flip side has been feeling emotionally flattened, our libidos tempered, blood pressure increases, blood clots and just generally feeling off.”

That sense of feeling ‘off’ – vague, hard to define but widely recognised – is fuelling a rethink. Dr Lucy Hooper, co-founder of Coyne Medical, is seeing the shift reflected in both data and her practice. According to recent NHS data, the proportion of women using the pill as their main form of contraception has nearly halved in the last decade. “Many women are worried about side effects,” she explains. “More open discussion on social media has empowered women to not just accept them.” A now iconic video on TikTok shows a young woman unfolding the list that comes with her pill packet, reading out the possible side-effects. It’s so long, she says, she could use it as a blanket. The video went viral and sparked a trend. Plus, research released only this week shows women are also increasingly avoiding the coil due to the pain of the procedure and inadequate pain relief being offered. Alongside this sits something more pointed: responsibility. “Women are tired of being the ones bearing the responsibility – both physically and mentally,” Emma adds.

Is this really about health – or about how sex feels?

It’s tempting to frame this shift as a move towards ‘natural’ sex – fewer barriers, more connection and a sense of ease. “There’s a shared and growing belief that ‘natural’ sex feels better, more intimate and more connected,” says Mariàn Martinez, Smile Makers Collection’s in-house sex coach and relationship expert. “It removes barriers and creates a sense of ease that many people crave.” That ease, though, comes with an edge. Strip everything back, and what’s really being prioritised is uninterrupted pleasure – sex without pauses and without reminders of consequence. “There’s a strong fantasy of control behind the pull-out method,” Mariàn adds. “The idea that ‘I can stop in time’ or ‘we’ve done it before, nothing happened.’” 

Dr Iranthi Methtananda, consultant obstetrician and gynaecologist at Welbeck London adds that while the pull-out method is often grouped into ‘natural contraception’, it’s quite different from evidence-based fertility awareness methods. “True fertility awareness involves tracking physiological markers such as basal body temperature and cervical mucus, and when used correctly, can be significantly more effective. Withdrawal, by contrast, is not based on ovulation tracking and remains considerably less reliable. It may appeal as a hormone-free option but it does not offer the same level of structure or effectiveness as more formal natural methods.”

How risky is it?

“The withdrawal method is one of the least effective ‘methods’ of contraception,” says Lucy. “It fails about 20% of the time over a year. Put simply, if five couples rely on it for a year, one of them is likely to end up pregnant.” The pull-out method relies on timing control and consistency – every single time – and even a slight delay can be enough to result in pregnancy, explains Iranthi. “It sounds simple but in practice, the pull-out method depends on several things going right every single time – recognising the point just before ejaculation, withdrawing early enough, and making sure semen doesn’t reach the vulva or vagina. It’s also very vulnerable to human error and that gap between ‘perfect’ and ‘typical’ use is exactly why pregnancy rates are so much higher in everyday life.”

There’s also the question of pre-ejaculate. “In one study only 12.9% of samples contained semen,” says Lucy, “but we only have limited scientific data, and the high failure rate suggests it’s not the sole reason it fails.” 

How does it play out in real life – and why does it stick?

“More often than not, the pull-out method just happens,” says Emma. “You get caught up and what can start as a one-off can quickly become a habit or routine, without anyone actually agreeing to it.” Which is exactly what makes it so seductive – and messy. No big conversation, no clear decision, just a subtle slide from ‘once’ to ‘most of the time’. Mariàn sees the same pattern. “Up to 60% of couples have used withdrawal at some point,” she explains, though only a small percentage rely on it exclusively. Instead, it exists in the grey area – a fallback, a default, or something that slips in when things feel more spontaneous.

Who’s really taking the risk here?

On paper, it’s one of the few contraceptive methods where responsibility appears to shift – the defining moment sitting, quite literally, with him. In reality, it’s far less equal. “Execution-wise yes,” says Emma. “Mental-load wise? No.” Because while the act itself lasts seconds, the aftermath lingers. “He might be the one physically pulling out but she carries the aftermath,” Mariàn says. That aftermath may look like tracking cycles, second-guessing symptoms, holding low-level anxiety, and being the one to take a pregnancy test ‘just in case.’ The problem is, say the experts, couples aren’t talking about it. “Sex is still one of the hardest things for couples to talk about openly,” says Emma, “So the pull-out method can very easily end up being used by assumption rather than agreement.” And when something goes wrong, says Mariàn, “that’s when the conversation finally happens.”

What does it say about how we’re having sex now?

On its own, the return of the pull-out method might feel surprising. Zoom out, and it starts to make sense. It’s part of a much wider shift in how women are approaching their bodies. Lucy points to growing concerns around mood, weight and long-term health, as well as a sense that many women weren’t fully informed when they first went on the pill. Around half, she notes, stop taking it within 12 months – most commonly due to irregular bleeding, headaches, mood changes and weight gain. At the same time, interest in fertility awareness-based methods is rising, from simple cycle tracking to more advanced monitoring using temperature and hormone markers. But even these come with a wide margin of error, with failure rates ranging anywhere from 2% to 33%.

So – is it ever a good idea?

For all the nuance, the experts are clear – this isn’t something to be casual about. “I would be most worried about anyone who really didn’t want to be pregnant,” says Lucy, pointing to its 20% failure rate – and the fact it offers no protection against STIs, which can lead to chronic pain and infertility. As Mariàn puts it: “If you’re going to choose it, don’t treat it casually – be honest about what you’re willing to hold if things don’t go as expected. Calling something ‘natural’ doesn’t make it neutral – it just makes it easier to justify. Yes, this kind of sex can feel freer, but pregnancy is natural too. The real question isn’t what feels good in the moment, but whether you’re prepared to take responsibility for everything that comes with it. And if what you’re really looking for is more connection and more sensation, there are ways to explore that, whether through better communication or using tools and toys designed for pleasure, which don’t rely on uncertainty or pressure in the moment.”

Visit THEKNUDESOCIETY.COM, COYNEMEDICAL.COM, SMILEMAKERSCOLLECTION.COM & LONDONWELBECKHOSPITAL.CO.UK