Millions of us use withdrawal method during sex – but is it ever really safe?

NEW research has revealed that more women in Europe rely on the “withdrawal” method of contraception than anywhere else in the world.

The results, which come from analysis of a UN report by , show that 7.8 per cent of couples use the method, even though it is one of the least reliable – with a 27 per cent failure rate in couples who don’t time it perfectly.

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“Pulling out” dominates Southern Europe, Southern Asia and Western Asia as a popular method of contraception – and has even overtaken the Pill in some countries, such as Iran.

The Sun’s Dr Carol Cooper explains: “The withdrawal method is just about the least effective method there is, if you can even call it a method at all."

The report also found that 63.6 per cent of married women or women in a relationship use some form of contraception - with the remaining 36.4 per cent not using any birth control at all.

The withdrawal method is just about the least effective method there is, if you can even call it a method at all

Dr Carol Cooper

We all know how to use condoms - but with so many types of contraception available for free in the UK, it can be hard to know which one is the best. So to help you decide, Dr Carol explains the pros and cons - and most importantly, the reliability - of some popular methods.

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The Combined Pill

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According to the , the combined pill's two hormones - oestrogen and progestogen - prevents ovulation, thickens cervical mucus to prevent sperm reaching an egg and thins the lining of the womb to prevent a fertilised egg implanting. You have to take a pill everyday – with a one week “break” every month, during which you’ll get your period.

Dr Carol says: "One of the most reliable reversible methods. Failure of the method is usually due to forgetting one or more pills, or having an upset stomach. The main downside is that it's not suitable for everyone, like smokers over 35."

The Progestogen Only Pill

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Often called the mini-pill, this pill has to be taken everyday continuously, and can stop some women from having periods altogether.

Dr Carol says: "Can be almost as effective as the combined pill, but it usually needs to be taken at the same time each day. It's ideal for breastfeeding women, and for those who like the pill but can;t take the combined Pill. The drawback is that it can cause irregular periods."

Implant

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The implant is a small flexible rod inserted under the skin the upper arm. When it place, it releases  progestogen - and it works for three years.

Dr Carol says: "Very effective as a long-term reversible contraceptive, because you can get it and forget it.No pills to remember, and it works even if you're on antibiotics or have a stomach bug. But it can lead to irregular periods, and they can take a while to get back to normal after the implant is removed."

Injection

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The injection also uses progestogen, and lasts for thirteen weeks or eight weeks, depending on the brand used.

Dr Carol says: "Very effective for up to 3 months at a time without the bother of remembering to take pills, but it can cause breast tenderness, mood changes and irregular periods. If you don't like the side effects, you can't reverse the injection. You just have to wait till it wears off."

The Coil

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The coil is a small, T-shaped device which is inserted into the womb by a doctor. It comes in two varieties - one which releases progestogen and another non-hormonal version made of copper. Depending on the type, the coil can last from three to ten years.

Dr Carol says: "Very effective but can increase the risk of pelvic infections and tends to make periods heavier (this is not the case with the IUS or 'intra-uterine system' which is a kind of coil containing progestogen hormone). It's also slightly less effective than the Pill or IUS - but still a lot more effective than withdrawal."

The Ring

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The ring is a small, flexible plastic device. When inserted into the vagina it releases oestrogen and progestogen, like the combined pill.

The Patch

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The patch releases the same hormones as the ring and the combined pill, but is simply stuck onto the skin and replaced every week for three weeks, before taking a one week break.

Dr Carol says: "Both patch and ring work like the Pill but the advantage is that an upset stomach doesn't make them work less well. Not for smokers over 35 or anyone at risk of DVT."

Natural Family Planning

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Some women choose to use fertility indicators such as body temperature to identify the "fertile" and "infertile" points in their cycle.

Dr Carol says: "Completely drug-free, so in theory no side-effects. However you have to be really motivated for it to be an effective method, and both partners need will-power. It's usually only up to 75% effective, though potentially it can be more reliable than this, especially for women with a very regular cycle."

Emergency Contraceptive Pill

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If all else fails, emergency contraceptive pills can be taken after having sex. Pills containing levonorgestrel can be taken up to three days after sex, while pills with ulipristal acetate – can be taken up to five days after.

Dr Carol says: "About 1.4% failure rate, so not quite as effective as most other methods, even when it's used in the first few hours. Anyone with a regular sex life needs a more regular method."