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International Journal of Medicine and Biomedical Research

DOI:10.14194/ijmbr.3.1.1
Authors:
Fanuel Lampiao at Kamuzu University of Health Sciences
Fanuel Lampiao
  • Kamuzu University of Health Sciences
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Abstract

Background: Coitus interruptus has been practiced since ancient times. Despite the development of other modern contraceptive methods, coitus interruptus is still practiced by people of all ages but commonly among adolescents. Aim: This mini review highlights recent research findings about coitus interruptus and the debate of whether spermatozoa exist in the pre-ejaculate. Methods: A literature search was performed using PubMed, and Google Scholar search engines. Literature reviewed included reviews, and original articles that evaluated the presence of spermatozoa in the pre-ejaculatory fluid. Articles reporting about coitus interruptus as a method of contraception were also reviewed. Results: Only three original articles which investigated the presence of spermatozoa in pre-ejaculatory fluid were found. Twelve articles reporting about coitus interruptus as a contraceptive method were also found and reviewed. Conclusion: The few literature reporting about the presence or absence of spermatozoa in the pre-ejaculatory fluid indicate the little interest researchers have on this subject even though there is enough evidence indicating that coitus interruptus is a widely practiced contraceptive method. It is therefore imperative to those who practice coitus interruptus to be aware about the background, strengths, and shortcomings of this method.
Available via license: CC BY-NC-SA 4.0
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International Journal of Medicine and Biomedical Research
Volume 3 Issue 1 January – April 2014
www.ijmbr.com
© Michael Joanna Publications
Mini Review
Int J Med Biomed Res 2014;3(1):1 -4
1
Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?
Lampiao F.
Department of Basic Medical Sciences, Division of Physiology, College of Medicine, P/Bag 360, Chichiri, Blantyre
3, Malawi.
Corresponding author: flampiao@medcol.mw
Received: 10.10.13; Accepted: 04.02.14; Published: 30.03.14
INTRODUCTION
Coitus interruptus, also known as the withdrawal
method, is the oldest form of male contraceptive
method to be practiced.[1] It involves the male partner
pulling out the penis before ejaculation.[1] Even though
it is the oldest method of male contraception to be
practiced, research has given it very little attention.
The few studies that have been conducted suggest that
it is widely practiced by men of all ages but more
common among adolescents.[2] Some studies have
reported its prevalence rate to vary between 9% and
48%.[3-5] A study in America reported the prevalence
rate of coitus interruptus to be as high as 60% among
sexually active black adolescents living in low-income
urban areas.[2]
During sexual arousal and the plateau phase, but
before ejaculation, the penis discharge a fluid called
the pre-ejaculatory fluid.[6] Pre-ejaculatory fluid is a
clear, colourless, and viscous fluid that is secreted by
the bulbourethral glands (Cowpers’s glands), with the
glands of Littre (mucus-secreting urethral glands) also
ABSTRACT
Background: Coitus interruptus has been practiced since ancient times. Despite
the development of other modern contraceptive methods, coitus interruptus is still
practiced by people of all ages but commonly among adolescents. Aim: This mini
review highlights recent research findings about coitus interruptus and the debate
of whether spermatozoa exist in the pre-ejaculate. Methods: A literature search
was performed using PubMed, and Google Scholar search engines. Literature
reviewed included reviews, and original articles that evaluated the presence of
spermatozoa in the pre-ejaculatory fluid. Articles reporting about coitus
interruptus as a method of contraception were also reviewed. Results: Only three
original articles which investigated the presence of spermatozoa in pre-ejaculatory
fluid were found. Twelve articles reporting about coitus interruptus as a
contraceptive method were also found and reviewed. Conclusion: The few
literature reporting about the presence or absence of spermatozoa in the pre-
ejaculatory fluid indicate the little interest researchers have on this subject even
though there is enough evidence indicating that coitus interruptus is a widely
practiced contraceptive method. It is therefore imperative to those who practice
coitus interruptus to be aware about the background, strengths, and shortcomings
of this method.
Key words: Coitus interruptus, contraception, spermatozoa, pre-ejaculate,
cowper’s gland
Lampiao F : Spermatozoa in the pre-ejaculate
Int J Med Biomed Res 2014;3(1):1 -4
2
contributing.[7] There is great variation in the amount
of pre-ejaculatory fluid that men produce. Some men
do not produce the pre-ejaculatory fluid at all, while
others can secrete as much as 5 mL.[6,7] Many studies
have reported contradictory views about whether the
pre-ejaculatory fluid that men secret contains sperm or
not and if this sperm is capable of fertilizing the egg.[6,
8] This review highlights recent research findings about
coitus interruptus and the evidence of whether
spermatozoa is present or absent in the pre-ejaculatory
fluid.
LITERATURE REVIEW
What is the function of the pre-ejaculatory
fluid?
The pre-ejaculatory fluid secreted by the bulbourethral
and other accessory glands plays a role of
mechanically lubricating the urethra as well as
facilitating the passage of sperm by creating an
appropriate chemical environment in the urethra.[9] The
pre-ejaculatory fluid is also important in necessitating
semen coagulation.[10] The glycoproteins that are
present in the pre-ejaculatory fluid serve as lubricant
for the glans penis during sexual intercourse, and they
have also been reported to possess immunodefensive
properties.[9] Apart from the glycoproteins, the pre-
ejaculatory fluid also contains acid phosphatase.[9]
Very acidic environment is detrimental to spermatozoa
survival. The pre-ejaculate neutralizes acidity in the
urethra caused by urine thus creating a more
favourable environment for the passage of sperm.[9]
The vagina is normally an acidic environment, so the
deposition of the pre-ejaculatory fluid before the
emission of semen many create a more friendly
environment where spermatozoa can strive.[7]
Are there spermatozoa in the pre-ejaculatory
fluid?
Some people practice withdrawal method as a form of
birth control. During vaginal sex, this involved pulling
the penis out of the vagina just before ejaculation.[3]
There are numerous reports indicating that pregnancy
occurred even though the couple was practicing the
withdrawal method.[6] After ejaculation, whether by
masturbation or sex with a partner, sperm may be left
over in the urethra.[1] Urinating between ejaculations
may flush the urethra of these leftover sperm and
clears the way for the pre-ejaculatory fluid.[2] If sperm
remains in the urethra from a previous ejaculation,
they may be released with the pre-ejaculatory fluid and
may possibly lead to fertilization of the egg even if the
man were to pull out before ejaculating.[1]
Table 1: Summary of findings of the presence or absence of spermatozoa in the pre-ejaculatory fluid
Findings
Conclusion
References
Spermatozoa present in
the pre-ejaculatory
fluid
Some men repeatedly leak
sperm in their pre-
ejaculatory fluid while
others do not
Little spermatozoa is
present in the pre-
ejaculatory fluid
Killick et al. [11]
Pudney et al. [12]
Spermatozoa absent in
the pre-ejaculatory
fluid
Pre-ejaculatory fluid from
Cowper’s gland do not
contain sperm and
therefore cannot be
responsible for pregnancies
during coitus interruptus
Zukerman et al. [6]
Lampiao F : Spermatozoa in the pre-ejaculate
Int J Med Biomed Res 2014;3(1):1 -4
3
Spermatozoa have been reported to be found in
the pre-ejaculatory fluid with contradictions.
Some researchers have observed the presence of
spermatozoa in pre-ejaculatory fluid and have
since advocated against the use of coitus
interruptus as a safe means of contraception.[6]
On the other hand, some researchers reported that
sperm was not present in the expressed
secretions, citing faulty methodology for fluid
collection and ascribing reported cases of
pregnancies to late withdrawal.[8] Unpublished
results from our laboratory also indicate that
there are no spermatozoa in the pre-ejaculatory
fluid. In most of the studies which reported the
presence of spermatozoa in the pre-ejaculatory
fluid, there was no proper characterization of the
spermatozoa. Glass slide smears of pre-
ejaculatory fluid were obtained during foreplay
from at least two different occasions. One study
reported that 8 out of 23 pre-ejaculatory samples
contained a few small clumps of spermatozoa.[11]
Another study reported the presence of motile
spermatozoa in the pre-ejaculatory fluid,
however, the number of sperm in these pre-
ejaculatory fluid were very low.[12] This study
was therefore unable to explain how this findings
might translate into the chances of pregnancy if
these samples of pre-ejaculatory fluid were
deposited in the vagina.[12] None of the studies
that reported the presence of spermatozoa in the
pre-ejaculatory fluid attempted to analyze the
morphology of the spermatozoa found. Table 1
shows a summary of the findings of the presence
or absence of spermatozoa in the pre-ejaculatory
fluid.
The general view is that any sperm in the pre-
ejaculatory fluid must be the result of a previous
ejaculation and that men who practice withdrawal
should pass urine prior to coitus in order to wash
away any residual sperm.[8] This review shows
the findings that spermatozoa is absent in the pre-
ejaculatory fluid, and that the few studies that
reported the presence of spermatozoa was
possibly due to faulty methodology during fluid
collection by the study participants.
Advantages and risks of coitus interruptus
There are a number of reasons why couples
prefer coitus interruptus over other forms of
contraception. Coitus interruptus costs nothing, it
cannot be forgotten when the couple goes away
from home, and it requires no medical
supervision.
The disadvantage of non-barrier contraceptive
methods such as coitus interruptus and hormonal
contraceptives is that they do not prevent the
transmission of sexually transmitted infections
(STIs). Studies have demonstrated the presence
of HIV in most pre-ejaculate samples from
infected men.[11,13] Withdrawal is known to be
associated with higher rate of unintended
pregnancy.[14] This is an important public health
concern because unintended pregnancies are
associated with adverse effects including delayed
prenatal care, pre-maturity and low birth
weight.[15] A study revealed that among
withdrawal users, one out of four women
reported that they terminated a pregnancy
because it was unplanned.[16] Thus, it is likely
that high rates of withdrawal use lead to
unnecessary, even illegal and perhaps dangerous
abortions, or to births that are mistimed or
unwanted.[16]
CONCLUSION
There is evidence in the literature indicating that
coitus interruptus is a widely practiced
contraceptive method. It is important to
acknowledge the fact that it can prevent
unwanted pregnancy. This review supports the
reports that there are no spermatozoa in the pre-
ejaculatory fluid and that the reported presence of
spermatozoa was due to faulty methodology
when collecting the pre-ejaculatory fluid. This
review recommends to those who use coitus
interruptus as a contraceptive method to urinate
between ejaculations so that they may flush the
urethra of the leftover spermatozoa to clear the
way for the pre-ejaculatory fluid.
References
1. Free M, Alexander NJ. Male contraception
without prescription: a revaluation of the condom and
coitus interruptus. Public Health Reports 1976; 91:439-
445.
2. Sznitman SR, Romer D, Brown LK,
Diclemente RJ, Valois RF, Vanable PA, Carey MP,
Stanton B. Prevalence, correlates, and sexually
transmitted infection risk related to coitus interruptus
among African-American adolescents. Sex Transm Dis
2009; 36:218-220.
3. Everett SA, Warren CW, Santelli JS. Use of
birth control pills, condoms, and withdrawal among
US high school students. J Adolesc Health 2000;
27:112-118.
4. Hoff T, Greene L, Davis J. National survey
of adolescents and young adults: sexually health
Lampiao F : Spermatozoa in the pre-ejaculate
Int J Med Biomed Res 2014;3(1):1 -4
4
knowledge, attitudes, and experiences. Henry Kaiser
Foundation 2003.
5. Horner J, Salazar LF, Romer D. Withdrawal
(coitus interruptus) as a sexual risk reduction strategy:
perspectives from African-American adolescents. Arc
Sex Behav 2009; 38:779-787.
6. Zukerman Z, Weiss DB, Orvieto R. Does
pre-ejaculatory penile secretion originating from
Cowper’s gland contain sperm? J Assist Reprod Genet.
2003; 20:157-159.
7. Chudnocsky A, Niederberger CS. Copious
pre-ejaculation: small glands major headaches. J
Androl. 2007; 28:374-375.
8. Rogow D, Sonya H. Withdrawal: a review of
literature and an agenda for research. Stud Fam Plann
1995; 26:140-153.
9. Chughtai B, Sawas A, O’Malley RL, Naik
RR, Khan SA, Pentyala S. A neglected gland: review
of Cowper’s gland. Int J Androl 2005; 28:74-77.
10. Beil RE, Hart RG. Cowper gland secretion in
rat semen coagulation. Identification of the
potentiating factor secreted by the coagulation glands.
Biol Reprod 1973; 8:613-617.
11. Pudney J, Oneta M, Mayer K, Seage G,
Anderson D. Pre-ejaculatory fluid as potential vector
for sexual transmission of HIV-1. Lancet 1992;
340:1470.
12. Killick SR, Leary C, Trussell J, Guthrie KA.
Sperm content of pre-ejaculatory fluid. Hum Fertil
2011; 14:48-52.
13. Ilaria G, Jacobs JL, Polsky B. Detection of
HIV-1DNA sequences in pre-ejaculatory fluid. Lancet
1992; 340:1469.
14. Riddle, John M. Contraception and Abortion
from the Ancient World to the Renaissance.
Cambridge, Massachusetts: Harvard University Press;
1992.
15. Brodie, Janet Farrell. Contraception and
Abortion in 19th-Century America. Ithaca, New York:
Cornell University Press; 1994.
16. Watkins, Elizabeth Siegel. On the Pill: A
Social History of Oral Contraceptives, 1950–1970.
Baltimore, Maryland: The Johns Hopkins University
Press; 1998.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 License
(http://creativecommons.org/licenses/by-nc-sa/3.0/) which permits unrestricted, non-commercial, share-alike use, distribution, and
reproduction in any medium, provided the original work is properly cited.
doi: http://dx.doi.org/10.14194/ijmbr.3.1.1
How to cite this article: Lampiao F. Coitus
Interruptus: Are there spermatozoa in the pre-
ejaculate? Int J Med Biomed Res
2014;3(1):1-4
Conflict of Interest: None declared
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Use of birth control pills, condoms, and withdrawal among US high school students
Article
To examine the use of contraception at last sexual intercourse among currently sexually active adolescents. We analyzed data from national school-based Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey which uses a national probability sample of U.S. students in public and private schools from grades 9 through 12. From 1991 to 1997, condom use significantly increased (from 46% to 57%), birth control pill use decreased (from 21% to 17%), and use of withdrawal significantly decreased (from 18% to 13%). In 1997, although more students were using condoms, 13% reported using withdrawal and 15% reported using no method to prevent pregnancy at last sexual intercourse. In 1997, condom use among females was significantly lower in the 9th grade than in the 12th grade (p <.001), whereas birth control pill use was higher (p <.001) and use of withdrawal remained stable. Among males, condom use and withdrawal use remained stable from 9th to 12th grade, whereas birth control pill use by their partner increased (p <.001). Inadequate contraceptive use among sexually active adolescents continues to be a major public health problem in the United States. For young people who will not remain sexually abstinent, families, health care providers, schools, and other influential societal institutions should promote the correct and continued use of condoms as essential protection against sexually transmitted diseases and human immunodeficiency virus infection.
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