Copper IUDvsWithdrawal

A side-by-side comparison of two birth control methods — efficacy, cost, how they work, and who shouldn't use them.

Side-by-side comparison

Method	Copper IUD A small copper device placed in the uterus that works for up to 10 years and is over 99% effective.	Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.
Efficacy	99.2% typical use Most effective: over 99 out of 100 people successfully prevent pregnancy per year.	80% typical use Least effective: under 90 out of 100 people successfully prevent pregnancy per year.
Cost	$0–$1,424 Insurance: Usually	$0 Insurance: Varies
Duration	Up to 10 years	Per act
Reversibility	Reversible	Reversible
STI Protection	No	No
How it works	Releases copper ions into the uterus that make the environment toxic to sperm and may prevent implantation if fertilization occurs.	The man withdraws his penis from the vagina before ejaculation to keep semen out of the vagina. Pre-ejaculate may contain some sperm, which is why perfect use is not 100%. A 2024 pilot study found sperm in about 13% of pre-ejaculate samples, though roughly 75% of participants had no sperm in any sample.
Prescription	Required Prescription required	OTC No prescription / OTC
Side effects	Heavier or longer periods (especially first few months) Increased cramping Spotting between periods Small risk of uterine perforation at insertion	None reported
Who shouldn't use this	Active pelvic infection or PID (FDA label) Uterine anomaly preventing insertion (FDA label) Wilson's disease (copper metabolism disorder) (FDA label) Known copper allergy (FDA label) Current pregnancy (FDA label)	Partner unable to withdraw consistently before ejaculation Need for highly effective contraception

Key differences

Copper IUD is more effective (99.2% vs 80% typical use). Copper IUD duration: Up to 10 years. Withdrawal duration: Per act. Copper IUD requires a prescription; Withdrawal does not. Copper IUD: costs $0–$1,424. Withdrawal: costs $0.