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Actually, the Pull-Out Method Is Pretty Effective

Memo to Dan Savage: Nonstop anal isn’t the only option for pregnancy-free unprotected sex

In a world full of reminders that all sex is inherently risky, and a once-treatable STD like gonorrhea threatens to morph into an incurable strain, there is a horny man among us who dares to fly too close to the (sex) sun. An advice-seeker named FIVEDAYS (Fucking Is Very Exciting, Dan, As You Say) has written into sex columnist Dan Savage asking how to dodge a bullet: He wants to know how to have five straight days of unprotected sex with his lady lover without getting her knocked up.

He writes:

Straight male fan, Dan. I’m visiting with a lover Jan 10–15th before she leaves the country for a while. We want to have a week of amazing passionate no-condom sex. It will be the week right before her period usually falls. STD risk already addressed. My question is what is the best birth control option for us in such a strictly short term scenario. We don’t want to use spermicide or a diaphragm. Having a baby together is definitely not an option right now. Our idea is to use ella or Plan B or something equally effective after our fucking marathon. Do you feel this would be a sound decision? If not, what would you recommend?

Fucking Is Very Exciting, Dan, As You Say

First things first: This guy is lucky, lucky to have five whole days off in January after all that holiday time he probably just took. Second, here is a man with a partner so enthusiastic about having a lot of sex with him that they are both willing to throw caution to the wind, while simultaneously trying to get their hands on some caution. Sure, it’s not the before kind of caution — kind of a critical distinction — but caution is caution, right?

It’s an ambitious goal, not least because setting yourself up for the pressure of a “week of amazing passionate no condom sex” is just asking to spend the whole time fighting over what kind of takeout to get till one of you storms out of the sex cave in tears because the other got the wrong type of curry. Still. The question fascinates because it boldly owns a reality most of us pretend we’re never guilty of — the “she’s just about to get her period so it’s probably fine to have unprotected sex” line of thinking.

It probably is fine, all things considered. Lots of people use the withdrawal or pull-out method, a practice that turns out to be far more common than people realize, as prevalent among 20-somethings too drunk to insist on a condom during a casual hookup as it is among older women in long-term monogamous relationships who, for whatever reason, are okay with rolling the dice.

What’s more, the medical community has begrudgingly come around to the fact that, STD risk aside, the old heave-ho is actually not as ineffective as once believed. One 2009 study rated the method as only “slightly less effective” than condoms.

That said, the problem here is that FIVEDAYS is not embarking on a drunken hookup — he’s planning in advance. Nor is he in a long-term relationship where a baby is fine — a baby would harsh their buzz, and apparently so would a simple barrier method like condoms or a diaphragm. What FIVEDAYS wants is all the fun and none of the consequences, which is like getting plastered but hoping you won’t wake up to a ghastly hangover. No judgment! We all want that kind of controlled hedonism. The problem is, it’s not realistic.

Savage hits right on one theoretically perfect solution. “I would recommend anal, FIVEDAYS,” Savage writes. “All the kinds.” But maybe anal isn’t their jam, or at least not five days’ worth. Savage does break down the relative risk here, citing research at Planned Parenthood: If pregnancy is most likely to happen in the six days before ovulation, then the week before your uterus sheds its nutrient-rich lining is probably not going to be ripe for fertilization. In other words, it’s possible, but not common, assuming you’re not wrong about when you ovulate, and lots of people are. If you want to just pop a morning-after type pill to cover your bases, Ella is better than Plan B because it can be taken as late as five days after intercourse, whereas Plan B decreases in effectiveness by the hour.

But here’s where it gets dicey, because Savage makes morning-after options sound a little too cavalier. I put FIVEDAYS’ question and Savage’s answer to a friend who is a women’s health nurse practitioner (but who did not want to be identified because of her current employment), who told me: “Plan B is for accidents, not planned accidents, and is not effective enough for this scenario. It’s less effective than other methods and not to be relied on first-line.” Emergency contraception may fail (it’s only 85 percent effective), she continued, and given the nasty side effects possible with Plan B — vomiting, bloating, cramping, headaches, to name a few (and they’re the same with Ella) — it doesn’t seem fair that the passionate, consequence-free sex side effects only come down on the woman, especially right before she’s getting on a long-ass flight to another country.

“Sex is great!” she wrote. “But you have LOTS of options to protect yourself against pregnancy. There is no reason to avoid all of them and just hope that the timing works out. And of course it’s the guy suggesting Plan B. He’s never had to take any hormones I’m sure,” she added.

Slapping on a condom or popping in a diaphragm would be relatively easy to incorporate into the sexfest, she added, pointing to a handy flowchart that helps a person decide all the pros and cons of choosing a new birth control based on how quickly it would be effective. A reader tweeted to Savage that if the woman had started the pill, patch or ring, for instance, she’d be protected in plenty of time.

Sure, FIVEDAYS and his lady can cross their fingers and hope for the best, and many people do and come out just fine. And it’s worth noting that hormonal birth control isn’t great for all women — it makes some of us feel like utter shit and is not without risks and potential side effects, from weight gain and acne, to headaches, mood swings, blood clots and even, possibly, certain types of cancer. That’s why many women prefer non-hormonal birth control like some IUDs. (And of course all of these can fail.) And condoms? Well, does anyone actually enjoy them?

But routine unprotected sex has a high chance of resulting in unintended pregnancy, which is also no walk in the park. About 43 million women in the U.S. who are at such risk, according to the Guttmacher Institute — meaning old enough to be having sex and fertile enough to still get knocked up — and if you’re part of a couple having unprotected sex regularly, you have about an 85 percent chance of pregnancy within the year.

“There is no safe time to have unprotected sex,” my nurse practitioner friend told me. “This has been covered ad nauseam in every publication since the beginning of the written word. I’d recommend an IUD or a diaphragm. They should also go to the health department together and get a stern talking-to.”

Yes, this is the conundrum all modern-day sex-havers must face. And while the answer is still a major bonerkiller to FIVEDAYS, so is the idea of the woman being the only one responsible for the consequences of unprotected sex. Let’s all do better.