title: Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure.
abstract: OBJECTIVE
  Use of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors.
  
  
  METHODS
  Using data from the 2006-2010 National Survey of Family Growth, we assessed reports of any and only withdrawal use at last sexual episode in the last month from 3517 sexually active 15 to 24 year-old women and men at risk of unintended pregnancy. Logistic regression documented associations with withdrawal.
  
  
  RESULTS
  Fourteen percent of young women and 17% of young men reported any use of withdrawal at last sex; 7% and 6%, respectively, reported only use of withdrawal. Though associated with few sociodemographic factors, withdrawal was significantly linked with pregnancy- and condom attitudes. In regression models, compared to those who said they would be upset if they discovered they were pregnant, young women who said they would be pleased about a pregnancy were 2.2-2.6 times as likely to have used any/only withdrawal (p<.01). For both women and men, those who felt that condoms were likely to diminish sexual pleasure were more likely to have used any/only withdrawal (odds ratio=1.8-2.6, p<.05).
  
  
  CONCLUSIONS
  At their last sexual episode, a greater proportion of young adults used withdrawal in conjunction with other methods than by itself. The psychological and sexual variables of orientation toward pregnancy and attitudes about condoms and pleasure were more strongly linked with withdrawal practices than most sociodemographic variables.
  
  
  CONCLUSIONS
  Since a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.
authors.affiliation: Department of Gender and Women's Studies, University of Wisconsin-Madison, 3414 Sterling Hall, 475 North Charter St, Madison WI 53706, USA. Electronic address: jenny.a.higgins@gmail.com.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Higgins
authors.affiliation: Department of Sociology, University of Wisconsin-Madison, 4412 William Sewell Social Sciences, 1180 Observatory Drive, Madison WI 53706, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D003076:Coitus Interruptus / Q000523:psychology*; D017280:Condoms; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D057181:Pleasure; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011275:Pregnancy, Unwanted / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology; D055815:Young Adult
keywords: Coitus interruptus; Pregnancy ambivalence; Sexual pleasure; Withdrawal; Young adults