Withdrawal method: what the 5 hour rule and research show

Withdrawal can reduce pregnancy risk compared with having no method at all when it is done very carefully, but in real life it fails often. Research suggests that pre ejaculate usually has little or no sperm when there has not been a recent ejaculation, and that some residual sperm in the urethra may decrease over time and with urination. These findings come from small studies and have not been tested as a stand alone birth control strategy. The informal “5 hour rule” is based on these ideas, but it is not part of official medical guidelines.

Quick take

• Most estimates put typical use failure for withdrawal at about 22% per year and perfect use at about 4% per year. Perfect use is hard to maintain over time.
• Carefully collected samples in some small studies found low to no sperm in pre ejaculate when there had not been a recent ejaculation, although a few men still had sperm present.
• A small forensic study found motile sperm in post ejaculatory urine for up to about 4.5 hours in some men, and many men had no motile sperm after the first urination. The study was not designed as a test of contraception and called for more research.

What people mean by the 5 hour rule

After ejaculation, some sperm can sit in the urethra. A small forensic study of fertile men looked for motile sperm in urine samples taken after ejaculation and found motile sperm for up to about 4.5 hours in some men, with many men clearing motile sperm earlier, often after the first urination. The authors noted that more research is needed and did not present the findings as a contraceptive method (Forensic Sci. Int. 2010).

Because of this, some people talk about leaving a gap of several hours between ejaculations or urinating before another sexual encounter so that pre ejaculate is less likely to pick up residual sperm. This is best viewed as a possible risk reduction step only. It is not a guarantee, it is not based on large clinical trials, and it does not make withdrawal a highly effective form of birth control.

Does pre ejaculate contain sperm?

Older small studies found sperm in pre ejaculate for some men and not for others. Newer work that used strict collection protocols has reported low to no sperm in many pre ejaculate samples when there has not been a recent ejaculation that could contaminate the urethra. Even in these studies, a small number of men still had sperm present.

Because of this variation, clinicians usually assume that pre ejaculate can sometimes contain sperm and that pregnancy is still possible if semen or pre ejaculate reaches the vagina, even if no one ejaculates inside.

How to lower risk if you rely on withdrawal

• If you choose withdrawal, try to be honest about how often it is hard to pull out in time. Many couples find this difficult, especially during repeat rounds.
• Some people who use withdrawal choose to leave several hours between ejaculations or to urinate between encounters. This may lower the chance of residual sperm, but it has not been proven as a reliable rule and should not be seen as protection on its own.
• Consider avoiding the estimated fertile window if a pregnancy would be very difficult for you right now.
• Add condoms whenever you can. This lowers pregnancy risk further and provides some protection from many sexually transmitted infections (STIs).
• If ejaculation happened in the vagina, or withdrawal was late, ask a doctor, nurse or pharmacist as soon as possible about emergency contraception.
• Use a pregnancy test at the right time after a risk. Testing too early can give a false negative.

For many people, a more effective method such as an IUD, implant, shot, pill, ring or patch, often combined with condoms, gives a much lower pregnancy risk than relying on withdrawal alone. A clinician can help you compare options for your situation.

Limits you should know

• Human error is common. Many failures happen because withdrawal is late, intercourse resumes soon after ejaculation, or it is hard to judge timing in the moment.
• No STI protection. Withdrawal does not protect against STIs. Condoms are recommended for STI risk reduction.
• Effectiveness gap. Withdrawal is much less reliable than long acting reversible methods and condoms used consistently and correctly. If avoiding pregnancy is very important, talk with a clinician about methods with lower failure rates.

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