Archives of Sexual Behavior

, Volume 38, Issue 5, pp 779–787 | Cite as

Withdrawal (Coitus Interruptus) as a Sexual Risk Reduction Strategy: Perspectives from African-American Adolescents

  • Jennifer R. HornerEmail author
  • Laura F. Salazar
  • Daniel Romer
  • Peter A. Vanable
  • Ralph DiClemente
  • Michael P. Carey
  • Robert F. Valois
  • Bonita F. Stanton
  • Larry K. Brown
Original Paper


This study examined adolescents’ beliefs about the benefits and risks of withdrawal (coitus interruptus) with respect to both pregnancy and sexually transmitted infections (STIs). In the course of qualitative interviews with African-American youth aged 14–19 (n = 124) about sexuality and risk, 24 adolescents spontaneously introduced the subject of withdrawal as a sexual risk reduction strategy. Eighteen percent of the sexually experienced adolescents mentioned their own use of withdrawal as a contraceptive method. From adolescents’ accounts of their own and their peers’ use of withdrawal, we learned that the cultural meanings of withdrawal within the context of adolescent relationships were multifaceted. Using withdrawal could signal sexual prowess in male youth, was seen as promoting trust and caring within a stable relationship, and was seen as mitigating the risk of pregnancy. However, adolescents also recognized that withdrawal did not protect against most STIs. Beliefs about withdrawal as a gendered skill and as a sign of trust may undermine some adolescents’ attempts to negotiate condom use for protection against STIs.


Sexually transmitted infections HIV/AIDS Adolescents Withdrawal Contraception African-American 



This study was conducted through the iMPPACS network supported by the National Institutes of Mental Health (Pim Brouwers, Project Officer) at the following sites and local contributors: Columbia, SC (U01 MH66802; Robert Valois (PI), Naomi Farber); Macon, GA (MH066807; Ralph DiClemente (PI), Gina M. Wingood, Laura F. Salazar, Pamela J. Fleischauer; interviewers: Tekla Evans and Philip Williams); Philadelphia, PA (U01-MH066809; Daniel Romer (PI), Bonita Stanton, Jennifer Horner); Providence, RI (U01-MH-066785; Larry Brown (PI)); Syracuse, NY (U01-MH-66794; Peter Vanable (PI), Michael Carey, Rebecca Bostwick; interviewers: Tanesha Cameron, Larry Hammonds).


  1. Anderson, J. E., Santelli, J. S., & Morrow, B. (2006). Trends in adolescent contraceptive use, unprotected, and poorly protected sex, 1991–2003. Journal of Adolescent Health, 38, 734–739.PubMedCrossRefGoogle Scholar
  2. Beatty, L. A., Wheeler, D., & Gaiter, J. (2004). HIV prevention research for African Americans: Current and future directions. Journal of Black Psychology, 30, 40–58.CrossRefGoogle Scholar
  3. Bissell, M. (2003). Withdrawal: Historical, cultural, and current perspectives on its use. Canadian Journal of Human Sexuality, 12, 191–192.Google Scholar
  4. Bowleg, L. (2004). Love, sex, and masculinity in sociocultural context. Men and Masculinities, 7, 166–186.CrossRefGoogle Scholar
  5. Cates, J. R., Herndon, N. L., Schulz, S. L., & Darroch, J. E. (2004). Our voices, our lives, our futures: Youth and sexually transmitted diseases. Chapel Hill, NC: University of North Carolina.Google Scholar
  6. Centers for Disease Control and Prevention. (2000). Scientific evidence on condom effectiveness for sexually transmitted disease (STD) prevention. Workshop summary, Herndon, VA at accessed 6/15/2006.
  7. Centers for Disease Control and Prevention. (2006). Cases of HIV infection and AIDS in the United States, by race/ethnicity, 2002–2004. HIV/AIDS Surveillance Supplemental Report; 12 (No. 1) at, accessed 6/26/2006.
  8. Chesson, H. W., Blandford, J. M., Gift, T. L., Tao, G., & Irwin, K. L. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36, 11–19.PubMedCrossRefGoogle Scholar
  9. Crosby, R. A., Sanders, S., Yarber, W. L., & Graham, C. A. (2003). Condom-use errors and problems: A neglected aspect of studies assessing condom effectiveness. American Journal of Preventative Medicine, 24, 367–370.CrossRefGoogle Scholar
  10. Crosby, R. A., Yarber W. L., & Meyerson, B. (2000). Prevention strategies other than male condoms employed by low-income women to prevent HIV infection. Public Health Nursing, 17, 53–60.PubMedCrossRefGoogle Scholar
  11. De Vicenzi, I., for the European Study Group on Heterosexual Transmission of HIV. (1994). A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. New England Journal of Medicine, 331, 341–346.CrossRefGoogle Scholar
  12. De Visser, R. (2004). Delayed application of condoms, withdrawal, and negotiation of safer sex among heterosexual young adults. AIDS Care, 16, 315–322.PubMedCrossRefGoogle Scholar
  13. Donovan, B. (2000). The repertoire of human efforts to avoid sexually transmissible diseases: Past and present. Part 2: Strategies used during or after sex. Sexually Transmitted Infections, 76, 88–93.PubMedCrossRefGoogle Scholar
  14. Everett, S. A., Warren, C. W., Santelli, J. S., Kann, L., Collins, J. L., & Kolbe, L. J. (2000). Use of birth control pills, condoms, and withdrawal among U.S. high school students. Journal of Adolescent Health, 27, 112–118.PubMedCrossRefGoogle Scholar
  15. Eyre, S. L. (1997). The vernacular term interview: Soliciting social knowledge related to sex among adolescents. Journal of Adolescence, 20, 9–27.PubMedCrossRefGoogle Scholar
  16. Gilliam, M. L., Warden, M. M., & Tapia, B. (2004). Young Latinas recall contraceptive use before and after pregnancy: A focus group study. Journal of Pediatric and Adolescent Gynecology, 17, 279–287.PubMedCrossRefGoogle Scholar
  17. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter.Google Scholar
  18. Hoff, T., Greene, L., & Davis, J. (2003). National survey of adolescents and young adults: Sexual health knowledge, attitudes, and experiences. Henry J. Kaiser Foundation,
  19. Horner, J. R., Romer, D., Vanable, P. A., Salazar, L. F., Carey, M. P., Juzang, I., et al. (in press). Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents. Journal of Health Communication.Google Scholar
  20. Hsieh, H., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288.PubMedCrossRefGoogle Scholar
  21. Ilaria, G., Jacobs, J. L., Polsky, B., Koll, B., Baron, P., MacLow, C., et al. (1992). Detection of HIV-1 DNA sequences in pre-ejaculatory fluid. Lancet, 340, 1469.PubMedCrossRefGoogle Scholar
  22. Jones, R. (2004). Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young urban women. Research in Nursing and Health, 27, 185–197.PubMedCrossRefGoogle Scholar
  23. Kelly, P. J., Morgan-Kidd, J., Champion, J. D., & Wood, R. (2003). Sexuality knowledge, attitudes, and practices of young women in the juvenile justice system. Pediatric Nursing, 29, 271–275.PubMedGoogle Scholar
  24. Kreuter, M. W., & Haughton, L. T. (2006). Integrating culture into health information for African-American women. American Behavioral Scientist, 49, 794–811.CrossRefGoogle Scholar
  25. Miller, R. (2003). Withdrawal: A very great deal better than nothing. Canadian Journal of Human Sexuality, 12, 189–190.Google Scholar
  26. Population Reports. (2004). Contraceptive use. Population Reports, 32, 4–10.Google Scholar
  27. Pudney, J., Oneta, M., Mayer, K., Seage, G., & Anderson, D. (1992). Pre-ejaculatory fluid as a potential vector for transmission of HIV-1. Lancet, 340, 1470.PubMedCrossRefGoogle Scholar
  28. QSR International. (2002). Using NVivo in qualitative research (3rd ed.).
  29. Ranjit, N., Bankole, A., Darroch, J. E., & Sing, S. (2001). Contraceptive failure in the first two years of use: Differences across socioeconomic subgroups. Family Planning Perspectives, 33, 19–27.PubMedCrossRefGoogle Scholar
  30. Rogow, D., & Horowitz, S. (1995). Withdrawal: A review of the literature and an agenda for research. Studies in Family Planning, 26, 140–153.PubMedCrossRefGoogle Scholar
  31. Sandelowski, M., & Barroso, J. (2003). Classifying the findings in qualitative studies. Qualitative Health Research, 13, 905–923.PubMedCrossRefGoogle Scholar
  32. Santelli, J. S., Morrow, B., Anderson, J. E., & Lindberg, L. D. (2006). Contraceptive use and pregnancy risk among U.S. high school students. Perspectives on Sexual and Reproductive Health, 108, 106–111.CrossRefGoogle Scholar
  33. Seal, D. W., & Ehrhardt, A. A. (2003). Masculinity and urban men: Perceived scripts for courtship, romantic, and sexual interactions with women. Culture, Health and Sexuality, 5, 295–319.CrossRefGoogle Scholar
  34. SexSmarts Surveys. (2002). Teens and sexual health communication., accessed 02/07/2007.
  35. Sobo, E. J. (1993). Inner-city women and AIDS: The psycho-social benefits of unsafe sex. Culture, Medicine, and Psychiatry, 17, 455–485.CrossRefGoogle Scholar
  36. Sullivan, M. (1995, April). Teenage males’ beliefs and practices about contraception: Findings from comparative ethnographic research in high-risk neighborhoods. Paper presented at the annual meeting of the Population Association of America, San Francisco.Google Scholar
  37. Tolman, D., Striepe, M. I., & Harmon, T. (2003). Gender matters: Constructing a model of adolescent sexual health. Journal of Sex Research, 40, 4–12.PubMedCrossRefGoogle Scholar
  38. Trussell, J. (1995). On the efficacy of withdrawal. Studies in Family Planning, 26, 305–306.PubMedCrossRefGoogle Scholar
  39. Whitehead, T. L. (1997). Urban low-income African-American men, HIV/AIDS, and gender identity. Medical Anthropology Quarterly, 11, 411–447.PubMedCrossRefGoogle Scholar
  40. Worth, D. (1989). Sexual decision-making and AIDS: Why condom promotion among vulnerable women is likely to fail. Studies in Family Planning, 20, 297–307.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jennifer R. Horner
    • 1
    • 2
    Email author
  • Laura F. Salazar
    • 3
  • Daniel Romer
    • 1
  • Peter A. Vanable
    • 4
  • Ralph DiClemente
    • 3
  • Michael P. Carey
    • 4
  • Robert F. Valois
    • 5
  • Bonita F. Stanton
    • 6
  • Larry K. Brown
    • 7
  1. 1.Annenberg Public Policy CenterUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Annenberg School for CommunicationUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Rollins School of Public HealthEmory UniversityAtlantaUSA
  4. 4.Department of Psychology, Center for Health and BehaviorSyracuse UniversitySyracuseUSA
  5. 5.Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  6. 6.Department of PediatricsWayne State University, Children’s Hospital of MichiganDetroitUSA
  7. 7.Bradley/Hasbro Research CenterRhode Island HospitalProvidenceUSA

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