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ARTICLE OPENA qualitative study of sexuality and contraceptive choiceamong women using withdrawalGabrijela Simetinger1,2 ?© The Author(s) 2025, corrected publication 2025This study examines the impact of withdrawal on women’s sexuality and its continued use in Slovenia despite modern contraceptivealternatives. Through in-depth interviews with 45 Slovenian women using withdrawal, f i ndings reveal signif i cant effects on sexualsatisfaction, particularly pleasure and orgasm. Many participants reported decreased sexual desire due to pregnancy fears, while concernsabout their partner’s performance affected arousal. Diff i culties in achieving orgasm were common, with some experiencing reducedintensity and frequency. The decision to use withdrawal was often shaped by male preference, limited access to other contraceptivemethods, and societal judgment. Some women preferred withdrawal for its perceived naturalness, aligning with a cultural shift towardnaturalism, which may reinforce traditional gender roles and sexual norms. Historically, withdrawal was a widely accepted contraceptivemethod inf l uenced by social norms and a lack of alternatives. The contemporary preference for natural contraception continues despite itsrisks, demonstrating how cultural beliefs shape reproductive choices. The f i ndings underscore the need for comprehensive contraceptivecounselling that acknowledges both personal and societal factors affecting women’s decisions. Addressing these inf l uences can helpensure informed choices that enhance both sexual well-being and reproductive autonomy.IJIR: Your Sexual Medicine Journal (2026) 38:481–485; https://doi.org/10.1038/s41443-025-01148-wINTRODUCTIONWithdrawal, or ‘coitus interruptus’, remains a widely usedtraditional contraceptive method globally, with 53 million usersrepresenting 5.5% of all contraceptive users in 2020 [1]. Despiteadvances in and accessibility to modern contraceptives, with-drawal usage persists, with 9% of European couples and asignif i cant portion of Eastern European populations continuing toemploy this method [1]. In Slovenia, we have many moderncontraceptive methods (contraceptive pills, injections, vaginalcontraceptive rings, patches and intrauterine systems and devices)available, and they are all free of charge if a person has basichealth insurance. Still, in 2022, among 2996 women who had anabortion, 2097 reported not using any contraception, and 257, or45% of the remainder, used withdrawal contraception [2].Similarly, withdrawal-related induced abortions constitute thehighest percentage in Italy (39%) [3] and substantial proportionsamong immigrants in Sweden (25%) [4].The preference for withdrawal over hormonal contraceptives isincreasing among Slovenian women [5], which ref l ects a broaderEuropean trend favouring natural contraceptive methods. Thisshift warrants a deeper investigation into the reasons for choosingwithdrawal, which does not protect against sexually transmittedinfections and particularly given its less effective nature; the WorldHealth Organization cites a 4% failure rate with perfect use and22% with typical use [6].Withdrawal’s advantages include no cost, no chemical involve-ment, and no interference with lactation, appealing to thoseneeding immediate or temporary contraception, particularlyamong populations with religious or philosophical reservationsabout other methods [7]. However, withdrawal places signif i cantresponsibility on male partners, requiring high self-control andoften shifting focus from pleasure to performance, with a potentialimpact on sexual satisfaction [8, 9].A systematic review and meta-analysis focusing on postpartumcontraceptive use among women in low- and middle-incomecountries identif i ed that withdrawal is frequently adopted due toperceived low pregnancy risks associated with breastfeeding andpostpartum amenorrhea. These perceptions are often coupled withconcerns regarding the side effects of alternative contraceptivemethods and the lack of adequate family planning counselling [10].Concurrently, a multicentre qualitative study in the United Statesrevealed that women under the age of 25 favour withdrawal, citingits non-invasive nature and perceived lack of harmful effects on thebody [11]. Similarly, an Australian study [12] indicated that youngwomen regard withdrawal and similar methods as preferable tohormonal and more invasive contraceptive strategies. Whilegenerally satisf i ed, some participants noted that their reliance onless effective methods stemmed from a scarcity of alternatives,negative experiences with hormonal contraceptives, insuff i cientinformation about other options, and challenges in accessingdiverse methods [12]. Additionally, qualitative in-depth interviewswith 38 Black and Latino women aged 18–24 highlighted that manyopt for withdrawal to enhance intimacy with their partners andbecause they perceive condoms as redundant in monogamousrelationships or wish to accommodate their partners’ preferencesfor increased sexual pleasure [13].Received: 16 February 2025 Revised: 14 July 2025 Accepted: 25 July 2025Published online: 2 August 20251 Department of Gynaecology and Obstetrics, General Hospital Novo mesto, Novo mesto, Slovenia. 2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.? email: gabrijela.simetinger@siol.netwww.nature.com/ijir IJIR: Your Sexual Medicine Journal1234567890();,: