International Journal of Medicine and Biomedical Research Volume 3 Issue 1 January – April 2014 www.ijmbr.com © Michael Joanna Publications Mini Review Coitus Interruptus: Are there spermatozoa in the pre-ejaculate? Lampiao F. Department of Basic Medical Sciences, Division of Physiology, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi. Corresponding author: [email protected] Received: 10.10.13; Accepted: 04.02.14; Published: 30.03.14 ABSTRACT Background: Coitus interruptus has been practiced since ancient times. Despite the development of other modern contraceptive methods, coitus interruptus is still practiced by people of all ages but commonly among adolescents. Aim: This mini review highlights recent research findings about coitus interruptus and the debate of whether spermatozoa exist in the pre-ejaculate. Methods: A literature search was performed using PubMed, and Google Scholar search engines. Literature reviewed included reviews, and original articles that evaluated the presence of spermatozoa in the pre-ejaculatory fluid. Articles reporting about coitus interruptus as a method of contraception were also reviewed. Results: Only three original articles which investigated the presence of spermatozoa in pre-ejaculatory fluid were found. Twelve articles reporting about coitus interruptus as a contraceptive method were also found and reviewed. Conclusion: The few literature reporting about the presence or absence of spermatozoa in the pre- ejaculatory fluid indicate the little interest researchers have on this subject even though there is enough evidence indicating that coitus interruptus is a widely practiced contraceptive method. It is therefore imperative to those who practice coitus interruptus to be aware about the background, strengths, and shortcomings of this method. Key words: Coitus interruptus, contraception, spermatozoa, pre-ejaculate, cowper’s gland INTRODUCTION reported its prevalence rate to vary between 9% and [3-5] 48%. A study in America reported the prevalence Coitus interruptus, also known as the withdrawal rate of coitus interruptus to be as high as 60% among method, is the oldest form of male contraceptive sexually active black adolescents living in low-income [2] method to be practiced.[1] It involves the male partner urban areas. pulling out the penis before ejaculation.[1] Even though it is the oldest method of male contraception to be During sexual arousal and the plateau phase, but practiced, research has given it very little attention. before ejaculation, the penis discharge a fluid called [6] The few studies that have been conducted suggest that the pre-ejaculatory fluid. Pre-ejaculatory fluid is a it is widely practiced by men of all ages but more clear, colourless, and viscous fluid that is secreted by common among adolescents.[2] Some studies have the bulbourethral glands (Cowpers’s glands), with the glands of Littre (mucus-secreting urethral glands) also Int J Med Biomed Res 2014;3(1):1 -4 1 Lampiao F : Spermatozoa in the pre-ejaculate contributing.[7] There is great variation in the amount ejaculatory fluid also contains acid phosphatase.[9] of pre-ejaculatory fluid that men produce. Some men Very acidic environment is detrimental to spermatozoa do not produce the pre-ejaculatory fluid at all, while survival. The pre-ejaculate neutralizes acidity in the others can secrete as much as 5 mL.[6,7] Many studies urethra caused by urine thus creating a more have reported contradictory views about whether the favourable environment for the passage of sperm.[9] pre-ejaculatory fluid that men secret contains sperm or The vagina is normally an acidic environment, so the not and if this sperm is capable of fertilizing the egg.[6, deposition of the pre-ejaculatory fluid before the 8] This review highlights recent research findings about emission of semen many create a more friendly coitus interruptus and the evidence of whether environment where spermatozoa can strive.[7] spermatozoa is present or absent in the pre-ejaculatory fluid. Are there spermatozoa in the pre-ejaculatory fluid? LITERATURE REVIEW Some people practice withdrawal method as a form of What is the function of the pre-ejaculatory birth control. During vaginal sex, this involved pulling fluid? the penis out of the vagina just before ejaculation.[3] There are numerous reports indicating that pregnancy The pre-ejaculatory fluid secreted by the bulbourethral occurred even though the couple was practicing the [6] and other accessory glands plays a role of withdrawal method. After ejaculation, whether by mechanically lubricating the urethra as well as masturbation or sex with a partner, sperm may be left [1] facilitating the passage of sperm by creating an over in the urethra. Urinating between ejaculations appropriate chemical environment in the urethra.[9] The may flush the urethra of these leftover sperm and [2] pre-ejaculatory fluid is also important in necessitating clears the way for the pre-ejaculatory fluid. If sperm semen coagulation.[10] The glycoproteins that are remains in the urethra from a previous ejaculation, present in the pre-ejaculatory fluid serve as lubricant they may be released with the pre-ejaculatory fluid and for the glans penis during sexual intercourse, and they may possibly lead to fertilization of the egg even if the [1] have also been reported to possess immunodefensive man were to pull out before ejaculating. [9] properties. Apart from the glycoproteins, the pre- Table 1: Summary of findings of the presence or absence of spermatozoa in the pre-ejaculatory fluid Findings Conclusion References Spermatozoa present in 11 of 27 subjects (41%) Some men repeatedly leak Killick et al. [11] the pre-ejaculatory produced pre-ejaculate with sperm in their pre- fluid spermatozoa and 10 of these ejaculatory fluid while cases had some motile others do not spermatozoa Pudney et al. [12] 8 out of 23 pre-ejaculatory Little spermatozoa is samples contained a few small present in the pre- clumps of spermatozoa ejaculatory fluid Spermatozoa absent in None of the pre-ejaculatory Pre-ejaculatory fluid from Zukerman et al. [6] the pre-ejaculatory samples contained sperm, All Cowper’s gland do not fluid patients had sperm in routine contain sperm and sperm analysis therefore cannot be responsible for pregnancies during coitus interruptus Int J Med Biomed Res 2014;3(1):1 -4 2 Lampiao F : Spermatozoa in the pre-ejaculate Spermatozoa have been reported to be found in The disadvantage of non-barrier contraceptive the pre-ejaculatory fluid with contradictions. methods such as coitus interruptus and hormonal Some researchers have observed the presence of contraceptives is that they do not prevent the spermatozoa in pre-ejaculatory fluid and have transmission of sexually transmitted infections since advocated against the use of coitus (STIs). Studies have demonstrated the presence interruptus as a safe means of contraception.[6] of HIV in most pre-ejaculate samples from On the other hand, some researchers reported that infected men.[11,13] Withdrawal is known to be sperm was not present in the expressed associated with higher rate of unintended secretions, citing faulty methodology for fluid pregnancy.[14] This is an important public health collection and ascribing reported cases of concern because unintended pregnancies are pregnancies to late withdrawal.[8] Unpublished associated with adverse effects including delayed results from our laboratory also indicate that prenatal care, pre-maturity and low birth there are no spermatozoa in the pre-ejaculatory weight.[15] A study revealed that among fluid. In most of the studies which reported the withdrawal users, one out of four women presence of spermatozoa in the pre-ejaculatory reported that they terminated a pregnancy fluid, there was no proper characterization of the because it was unplanned.[16] Thus, it is likely spermatozoa. Glass slide smears of pre- that high rates of withdrawal use lead to ejaculatory fluid were obtained during foreplay unnecessary, even illegal and perhaps dangerous from at least two different occasions. One study abortions, or to births that are mistimed or reported that 8 out of 23 pre-ejaculatory samples unwanted.[16] contained a few small clumps of spermatozoa.[11] Another study reported the presence of motile CONCLUSION spermatozoa in the pre-ejaculatory fluid, however, the number of sperm in these pre- [12] There is evidence in the literature indicating that ejaculatory fluid were very low. This study coitus interruptus is a widely practiced was therefore unable to explain how this findings contraceptive method. It is important to might translate into the chances of pregnancy if acknowledge the fact that it can prevent these samples of pre-ejaculatory fluid were [12] unwanted pregnancy. This review supports the deposited in the vagina. None of the studies reports that there are no spermatozoa in the pre- that reported the presence of spermatozoa in the ejaculatory fluid and that the reported presence of pre-ejaculatory fluid attempted to analyze the spermatozoa was due to faulty methodology morphology of the spermatozoa found. Table 1 when collecting the pre-ejaculatory fluid. This shows a summary of the findings of the presence review recommends to those who use coitus or absence of spermatozoa in the pre-ejaculatory interruptus as a contraceptive method to urinate fluid. between ejaculations so that they may flush the urethra of the leftover spermatozoa to clear the The general view is that any sperm in the pre- way for the pre-ejaculatory fluid. ejaculatory fluid must be the result of a previous ejaculation and that men who practice withdrawal References should pass urine prior to coitus in order to wash away any residual sperm.[8] This review shows 1. Free M, Alexander NJ. Male contraception the findings that spermatozoa is absent in the pre- without prescription: a revaluation of the condom and ejaculatory fluid, and that the few studies that coitus interruptus. Public Health Reports 1976; 91:439- reported the presence of spermatozoa was 445. possibly due to faulty methodology during fluid 2. Sznitman SR, Romer D, Brown LK, Diclemente RJ, Valois RF, Vanable PA, Carey MP, collection by the study participants.