CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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74 MMWR June 18, 2010 Appendix J Coitus Interruptus (Withdrawal) Coitus interruptus (CI), also known as withdrawal, is a traditional family planning method in which the man completely removes his penis from the vagina, and away from the external genitalia of the female partner, before he ejaculates. CI prevents sperm from entering the woman’s vagina, thereby preventing contact between spermatozoa and the ovum. This method might be appropriate for couples • who are highly motivated and able to use this method effectively; • with religious or philosophical reasons for not using other methods of contraception; • who need contraception immediately and have entered into a sexual act without alternative methods available; • who need a temporary method while awaiting the start of another method; or • who have intercourse infrequently. Some benefits of CI are that the method, if used correctly, does not affect breastfeeding and is always available for primary use or use as a back-up method. In addition, CI involves no economic cost or use of chemicals. CI has no directly associated health risks. CI does not protect against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission. CI is unforgiving of incorrect use, and its effectiveness depends on the willingness and ability of the couple to use withdrawal with every act of intercourse. Women with conditions that make pregnancy an unacceptable risk should be advised that CI might not be appropriate for them because of its relatively higher typical-use failure rates.
Vol. 59 / RR-4 Recommendations and Reports 75 Appendix K Female and Male Sterilization Tubal sterilization for women and vasectomy for men are permanent, safe, and highly effective methods of contraception. In general, no medical conditions would absolutely restrict a person’s eligibility for sterilization (with the exception of known allergy or hypersensitivity to any materials used to complete the sterilization method). However, certain conditions place a woman at high surgical risk; in these cases, careful consideration should be given to the risks and benefits of other acceptable alternatives, including long-acting, highly effective, reversible methods and vasectomy. Female and male sterilization do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV). If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission. Because these methods are intended to be irreversible, persons who choose sterilization should be certain that they want to prevent pregnancy permanently. Most persons who choose sterilization remain satisfied with their decision. However, a small proportion of women regret this decision (1%–26% from different studies, with higher rates of regret reported by women who were younger at sterilization) (1,2). Regret among men about vasectomy has been reported to be approximately 5% (3), similar to the proportion of women who report regretting their husbands’ vasectomy (6%) (4). Therefore, all persons should be appropriately counseled about the permanency of sterilization and the availability of highly effective, reversible methods of contraception. References 1. Peterson HB. Sterilization. Obstet Gynecol 2008;111:189–203. 2. Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Poststerilization regret: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999;93:889–95. 3. Ehn BE, Liljestrand J. A long-term follow-up of 108 vasectomized men. Good counselling routines are important. Scand J Urol Nephrol 1995;29:477–81. 4. Jamieson DJ, Kaufman SC, Costello C, et al. A comparison of women’s regret after vasectomy versus tubal sterilization. Obstet Gynecol 2002;99:1073–9.
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CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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