{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T11:02:02Z","timestamp":1784458922295,"version":"3.55.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T00:00:00Z","timestamp":1562803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T00:00:00Z","timestamp":1562803200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"funder":[{"name":"The National Survey of Sexual Health and Behavior"},{"DOI":"10.13039\/100014939","name":"Church & Dwight Co, Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014939","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100014939","name":"Church & Dwight Co, Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014939","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100014939","name":"Church & Dwight Co, Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014939","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Although withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To measure respondents\u2019 frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal\/anal ejaculation during the most recent sexual event.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February\u2013March 2018 via GfK Research\u2019s KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy\/arousing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>Main outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25\u201329 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner\u2019s perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6\u201314.0) at last sexual event, whereas extra-vaginal\/anal ejaculation was reported by 20.8% (95% CI 18.7\u201323.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>The results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; Limitations<\/jats:title>\n                  <jats:p>This is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal\/anal ejaculation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We found that reporting of withdrawal as a contraceptive method vs extra-vaginal\/anal ejaculation was inconsistent and that extra-vaginal\/anal ejaculation was commonly used for reasons other than pregnancy\u00a0prevention; future research should use more precise measures of \u201cwithdrawal.\u201d<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.05.022","type":"journal-article","created":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T22:09:18Z","timestamp":1562882958000},"page":"1170-1177","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":14,"title":["Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior"],"prefix":"10.1093","volume":"16","author":[{"given":"Tsung-chieh","family":"Fu","sequence":"first","affiliation":[{"name":"Center for Sexual Health Promotion , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"},{"name":"Department of Applied Health Science , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon J.","family":"Hensel","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine , Indianapolis, IN , USA"},{"name":"Indiana University School of Medicine , Indianapolis, IN , USA"},{"name":"Department of Sociology , Indianapolis, IN , USA"},{"name":"Indiana University Purdue University-Indianapolis , Indianapolis, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon J.","family":"Beckmeyer","sequence":"additional","affiliation":[{"name":"Center for Sexual Health Promotion , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"},{"name":"Department of Applied Health Science , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Dodge","sequence":"additional","affiliation":[{"name":"Center for Sexual Health Promotion , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"},{"name":"Department of Applied Health Science , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debby","family":"Herbenick","sequence":"additional","affiliation":[{"name":"Center for Sexual Health Promotion , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"},{"name":"Department of Applied Health Science , Bloomington, IN , USA"},{"name":"Indiana University , Bloomington, IN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,11]]},"reference":[{"key":"2023012309450827800_bib1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.contraception.2017.10.003","article-title":"Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014","volume":"97","author":"Kavanaugh","year":"2018","journal-title":"Contraception"},{"key":"2023012309450827800_bib2","article-title":"Contraceptive methods women have ever used: United States, 1982\u20132010. National Health Statistics Reports","author":"Daniels","year":"2013"},{"key":"2023012309450827800_bib3","first-page":"1","article-title":"Unmarried men's contraceptive use at recent sexual intercourse: United States, 2011\u20132015. NCHS data brief","author":"Daniels","year":"2017"},{"key":"2023012309450827800_bib4","first-page":"1","article-title":"Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth","volume":"23","author":"Chandra","year":"2005","journal-title":"Vital Health Stat"},{"key":"2023012309450827800_bib5","article-title":"Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. National Health Statistics Reports","author":"Daniels","year":"2015"},{"key":"2023012309450827800_bib6","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/AOG.0b013e31829d8074","article-title":"Use of withdrawal and unintended pregnancy among females 15\u201324 years of age","volume":"122","author":"Dude","year":"2013","journal-title":"Obstet Gynecol"},{"key":"2023012309450827800_bib7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.contraception.2014.12.005","article-title":"Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure","volume":"91","author":"Higgins","year":"2015","journal-title":"Contraception"},{"key":"2023012309450827800_bib8","article-title":"Current contraceptive use in the United States, 2006\u20132010, and changes in patterns of use since 1995. National Health Statistics Reports","author":"Jones","year":"2012"},{"key":"2023012309450827800_bib9","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jadohealth.2018.05.017","article-title":"Changing patterns of contraceptive use and the decline in rates of pregnancy and birth among U.S. adolescents, 2007\u20132014","volume":"63","author":"Lindberg","year":"2018","journal-title":"J\u00a0Adolescent Health"},{"key":"2023012309450827800_bib10","first-page":"1","article-title":"Use of contraception and use of family planning services in the United States: 1982\u20132002. Advance Data from Vital and Health Statistics","author":"Mosher","year":"2004"},{"key":"2023012309450827800_bib11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.contraception.2015.08.015","article-title":"Withdrawal as pregnancy prevention and associated risk factors among US high school students: Findings from the 2011 National Youth Risk Behavior Survey","volume":"93","author":"Liddon","year":"2016","journal-title":"Contraception"},{"key":"2023012309450827800_bib12","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S1054-139X(99)00125-1","article-title":"Use of birth control pills, condoms, and withdrawal among U.S. high school students","volume":"27","author":"Everett","year":"2000","journal-title":"J\u00a0Adolescent Health"},{"key":"2023012309450827800_bib13","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1363\/3810606","article-title":"Contraceptive use and pregnancy risk among U.S. high school students, 1991\u20132003","volume":"38","author":"Santelli","year":"2006","journal-title":"Perspect Sex Reprod Health"},{"key":"2023012309450827800_bib14","first-page":"626","article-title":"\"Is that a method of birth control?\" A qualitative exploration of young women's use of withdrawal","volume":"53","author":"Arteaga","year":"2016","journal-title":"J\u00a0Sex Res"},{"key":"2023012309450827800_bib15","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.contraception.2008.12.008","article-title":"Better than nothing or savvy risk-reduction practice? The importance of withdrawal","volume":"79","author":"Jones","year":"2009","journal-title":"Contraception"},{"key":"2023012309450827800_bib16","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S0968-8080(05)25175-3","article-title":"Why withdrawal? Why not withdrawal? Men's perspectives","volume":"13","author":"Ortayli","year":"2005","journal-title":"Reprod Health Matters"},{"key":"2023012309450827800_bib17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1363\/4210210","article-title":"Withdrawal attitudes and experiences: A qualitative perspective among young urban adults","volume":"42","author":"Whittaker","year":"2010","journal-title":"Perspect Sex Reprod Health"},{"key":"2023012309450827800_bib18","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.contraception.2014.04.016","article-title":"Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women","volume":"90","author":"Jones","year":"2014","journal-title":"Contraception"},{"key":"2023012309450827800_bib19","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/09540120410001665321","article-title":"Delayed application of condoms, withdrawal and negotiation of safer sex among heterosexual young adults","volume":"16","author":"De Visser","year":"2004","journal-title":"AIDS Care"},{"key":"2023012309450827800_bib20","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.2105\/AJPH.2007.115790","article-title":"Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use","volume":"98","author":"Higgins","year":"2008","journal-title":"Am J Public Health"},{"key":"2023012309450827800_bib21","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s10508-007-9304-y","article-title":"Withdrawal (coitus interruptus) as a sexual risk reduction strategy: perspectives from African-American adolescents","volume":"38","author":"Horner","year":"2009","journal-title":"Arch Sex Behav"},{"key":"2023012309450827800_bib22","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.2196\/jmir.6.3.e34","article-title":"Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES)","volume":"6","author":"Eysenbach","year":"2004","journal-title":"J\u00a0Medical Internet Res"},{"key":"2023012309450827800_bib23","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1177\/1077801210382866","article-title":"Aggression and sexual behavior in best-selling pornography videos: A content analysis update","volume":"16","author":"Bridges","year":"2010","journal-title":"Violence Against Women"},{"key":"2023012309450827800_bib24","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1177\/1077801216666723","article-title":"Naked aggression: The meaning and practice of ejaculation on a woman\u2019s face","volume":"23","author":"Sun","year":"2017","journal-title":"Violence Against Women"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519312330?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519312330?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/8\/1170\/48588828\/jsm_16_8_1170.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/8\/1170\/48588828\/jsm_16_8_1170.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T10:22:00Z","timestamp":1674469320000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/16\/8\/1170\/6980575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,11]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,7,11]]},"published-print":{"date-parts":[[2019,8,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.05.022","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2019,8]]},"published":{"date-parts":[[2019,7,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.05.022","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}