Withdrawal: a review of the literature and an agenda for research.

A review to evaluate available literature about withdrawal (coitus interruptus) reveals a dearth of research on the current prevalence, acceptability, use-effectiveness, service-delivery issues, and safety of this ancient and widely used temporary contraceptive method. Population and family planning professionals are shown to have neglected withdrawal in favor of modern, female-controlled methods. This neglect is founded largely upon the popular belief that fertile levels of viable sperm are present in pre-ejaculatory fluid, despite data to the contrary. The validity of existing data on the prevalence of withdrawal is questioned because of the methodological bias inherent in most studies. The use-effectiveness of the practice and its relationship to sexually transmitted diseases have not been adequately investigated. A detailed research agenda on numerous topics concerning withdrawal is proposed.