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Coitus interruptus, also known as the outer ejaculation or "outside" method, is the oldest form of contraception in the world and is still practiced today. About 35 million couples worldwide rely on this technique for emergency pregnancy prevention.

What is external ejaculation?

External ejaculation, aka interrupted intercourse, is the practice of pulling the penis out of the vagina before it reaches climax and ejaculates. This pull-out technique is often used as a backup method of condoms or hormone pills.

During sex, a man will pull his penis out of the vagina when he feels like he is about to ejaculate or before reaching it. Ejaculation will be done separately, outside and away from the vagina, taking care not to let semen drip or spill onto the woman's vulva.

Men who want to use this method need to understand properly about their sexual response: when they orgasm, climax, and will ejaculate. You need to know when your body reaches its highest point of sexual arousal when ejaculation can no longer be suppressed or delayed.

This method does have several advantages. For example, hormone free and practical. In addition, spermine, a compound found in sperm, is actually quite good for your skin. Spermine is believed to smooth wrinkles and prevent acne. However …

There is a risk of sperm remaining in the pre-ejaculate semen

Using the intercourse method requires skills of self-control. Even if you can predict when to pull-out, this method will still not be as effective as other contraceptives at preventing pregnancy.

When you are excited, your penis will secrete a small amount of pre-ejaculatory semen. The pre-ejaculatory semen itself does not contain sperm. However, when the pre-ejaculatory fluid leaves the penis, the remaining live sperm that sticks to the urethra will be swept out with the semen.

A study quoted from the International Planned Parenthood found small clumps of sperm in pre-ejaculatory semen in a number of male participants. Even if only a few hundred sperm were present, in theory, there was still a risk of pregnancy - even if it was low. Remember, it only takes one sperm cell to make pregnancy happen.

The method of external ejaculation is no more effective than condoms

"We often think of intercourse] as a method of contraception, but it's not," says Lauren F. Streicher, MD, associate clinical professor of the OB-GYN department at Northwestern University and author of Sex Rx: Hormones, Health, and Your Best Sex Ever, quoted from the Greatist.

Contraception, by definition, is a method used to prevent pregnancy, but interrupted intercourse techniques have a very high chance of failure.

According to Planned Parenthood, 4 out of 100 women will get pregnant from a male partner who always uses the intercourse method.

This means that there is a four percent chance of pregnancy from this method. When compared with the birth control pill (6 percent failure rate) or the IUD (less than 1 percent chance of failure), this figure is actually quite high. Among couples who could not manage the timing of the pull-out, the odds of failure were estimated at 27 percent in one year.

Why? Most men can't accurately predict how to release the pull-out reflex as quickly as they want. What's more, a lot of men out there experience premature ejaculation.

Condoms, according to the CDC, have a failure rate of 18 percent. It is important to understand that this percentage comes from malfunctioning condoms due to men who do not understand the correct use of condoms - late in using condoms until just before sex or the wrong way to use them. Even though you and your partner cannot control accidents, such as torn condoms, if you really know how to use a condom properly, it is very unlikely that the two reasons above can happen. This means that your personal failure rate will be much lower with using a condom than by relying solely on intercourse techniques.

The method of external ejaculation does not protect against venereal disease

Genital lesions or ulcers can spread various kinds of infections. Other venereal diseases can be passed from one person to another through skin contact.

The semen of HIV-positive men contains active HIV cells and is the main mode of transmission of the virus through sexual contact. Using the intercourse method can reduce this risk because your partner is not exposed to semen. However, there remains a risk of HIV transmission from pre-ejaculated semen which may contain active HIV cells.

The method of interrupted intercourse does not prevent the spread of sexually transmitted diseases. The only thing that will be effective at protecting you is a condom, which is even better when combined with other contraceptives to also prevent pregnancy.