Breaking news from my pals at the Guttmacher Institute: withdrawal is an effective birth control method! But why don't more people use it and, furthermore, why don't doctors talk about it as an option? Here's their headscrataching concluding paragraph:
Although withdrawal may not be as effective as some contraceptive methods, it is substantially more effective than nothing. It is also convenient, requires no prior planning and there is no cost involved. Consistent dual use of withdrawal in conjunction with hormonal, barrier or other methods could constitute an effective contraceptive strategy. Health care providers and health educators should discuss withdrawal as a legitimate, if slightly less effective, contraceptive method in the same way they do condoms and diaphragms. Dismissing withdrawal as a legitimate contraceptive method is counterproductive for the prevention of pregnancy and also discourages academic inquiry into this frequently used and reasonably effective method. (page 10)
Earth to Guttmacher researchers, people do use it--here at the U of T at A, withdrawal (aka "pull and pray") is our 3rd most popular contraceptive method. And doctors do know about it, because it's listed in the method effectiveness table in Contraceptive Technology which appears in every single box of condoms, pack of birth control pills, and diaphragm container. There's actually a whole chapter on it in the 19th edition of Contraceptive Technology that features this extremely important point that Guttmacher fails to note, from the section "Disadvantages and Cautions":
"One reason for contraceptive failure may be a lack of the self-control demanded by the method. With impending orgasm, men (and women) experience a mild to extreme clouding of consciousness [!*] during which coital movement becomes involuntary. The man may feel the urge to achieve deeper penetration at the time of impending orgasm and may not withdraw in sufficient time to avoid depositing semen in his partner's vagina or on her external genitalia...For some couples, interruption of the excitement or plateau phase of the sexual response cycle may diminish pleasure." (pg. 339)
Contraceptive Technology, at least, acknowledges that there are pleasure implications of the withdrawal method that make it undesirable. Furthermore, I call bullshit on using withdrawal in conjunction with another method -- to do so is just paranoid. In my professional work, I encounter guys who pull out despite the fact that they're wearing a condom and the girl is on the pill, just because they are Completely Fucking Terrified of the girl getting pregnant. Those guys are not enjoying the sex they do have, because they're wearing a life jacket and a helmet and jumping off the raft before it goes over the waterfall. What's fun about that?
*I refer to this as "under the fuckluence," defined as "under the influence of fucking." As in, "I meant to use a condom but once we got started I was under the fuckluence and couldn't stop."