Internal CondomvsWithdrawal

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	Internal Condom A soft pouch worn inside the vagina that blocks sperm and protects against STIs, available by prescription.	Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.
Efficacy	79% typical use Least effective: under 90 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–$4 /per unit Insurance: Usually	$0 Insurance: Varies
Duration	Single use	Per act
Reversibility	Reversible	Reversible
STI Protection	Yes	No
How it works	A soft, loose-fitting nitrile pouch lines the vagina and collects semen. The inner ring anchors it at the cervix and the outer ring stays outside the vaginal opening.	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	Mild irritation or discomfort Noise during use if not positioned correctly Slippage with incorrect insertion	None reported
Who shouldn't use this	Sensitivity to nitrile (rare)	Partner unable to withdraw consistently before ejaculation Need for highly effective contraception

Key differences

Withdrawal is more effective (80% vs 79% typical use). Internal Condom duration: Single use. Withdrawal duration: Per act. Only Internal Condom protects against STIs. Internal Condom requires a prescription; Withdrawal does not. Internal Condom: costs $0–$4 per unit. Withdrawal: costs $0.