HIV risk of not ejaculating during sex

Estimating your risk of HIV infection is tricky business. While most people know that HIV is primarily transmitted through sex, does that mean the risks are the same for all types of sex?

The answer is no. Each type of sexual contact has its own risk of HIV transmission. For example, receiving anal sex has a higher risk of infection than receiving vaginal sex. Oral sex has the lowest risk of transmission.

But what if the inserted partner pulls out before ejaculation? Is the risk of HIV infection lower?

The answer to this question is neither simple nor simple. This article aims to explore the factors that contribute to HIV transmission and whether “pulling out” is an effective strategy for HIV prevention. Additionally, this article will explore ways to reduce HIV risk without consistently using external (or “male” condoms) and internal (or “female” condoms).

How did you get HIV?

HIV in ex-semen

You can only get HIV through direct contact with certain bodily fluids of someone living with HIV. These fluids are:

  • anal discharge
  • Blood
  • breast milk
  • semen
  • vaginal fluid

Although pulling out before ejaculation reduces the overall risk of transmission, it does not completely prevent it. Why? Because ex-semen can also contain viruses.

In HIV-infected people, semen is as potentially infectious as semen and contains roughly the same concentration of HIV. This means that even if the inserting partner pulls out before ejaculation, the receiving partner can still be exposed to HIV through the pre-semen fluid.


Pre-semen (“pre-cum”) contains approximately the same high concentration of HIV as semen. Pre-semen discharge can lead to infection during unprotected (also called “uncondom”) sex.

risk factor

Pre-semen fluids are generally considered to carry less risk of HIV infection because the amount of fluid released is usually lower than that of semen. However, there are many factors that increase this risk.

semen volume

Some men can produce large amounts of pre-semen. This is especially true after prolonged abstinence, where men can produce up to 6 ml or about 1-1/4 teaspoons of pre-fluid.

HIV viral load

Untreated HIV infection results in a high viral load. HIV viral load, a measure of the amount of virus in a blood sample, ranges from undetectable to over a million. Higher viral loads in blood correspond to higher concentrations of virus in the pre-solution.

anal sex

The risk of HIV infection is high with anal sex because the rectal tissue is fragile and can rupture easily. This allows the virus to enter the blood directly.

Meanwhile, the rectum has only a layer of cells that coat tissue rich in immune cells called CD4 T cells. These are the cells that HIV targets and infects. Therefore, even a small amount of fluid can cause an infection.

Sexually Transmitted Infections (STIs)

Some STDs like syphilis can cause ulcers, making it easy for HIV to enter the body. Other diseases, such as gonorrhea, cause inflammation that attracts immune cells, including CD4 T cells, to the site of infection, giving HIV more targets for infection. These factors increase the risk of infection.

Studies have shown that having gonorrhea or chlamydia increases the risk of HIV infection by 800%.

HIV shedding

STIs or similar infections can also increase the amount of virus in semen through a process called viral shedding. Inflammation caused by infection can accelerate the production of HIV virus in genital tissues. The virus then “sheds” into semen and semen, increasing their infectivity.

Even people with undetectable viral loads in blood may have HIV detectable in semen and pre-semen fluid due to shedding.


Although HIV concentrations in semen are lower than in semen, certain factors increase the risk of HIV infection, including a high viral load, having an STI, or having anal sex.

Weigh the risks

Finally, there is no hard and fast rule about “how much” or “how much” pre-semen is needed to cause HIV infection. There are many variables that play a role in determining a person’s risk.

While pulling out before ejaculation may reduce the chance of transmission, it doesn’t eliminate it. For example, one study showed that those who ejaculated had roughly twice the risk of having unprotected anal sex without a condom than those who quit. While the risk of contracting HIV after withdrawal is low, there are definitely risks.

If you don’t always use an external or internal condom, there are some ways to reduce your risk of getting HIV or passing it on to others:

  • If you do not have HIV, you can start HIV pre-exposure prophylaxis (PrEP), which can be given as a daily pill or as an injection every two months. Using PrEP can greatly reduce the risk of contracting HIV.
  • If you have HIV, you can reduce your risk of infecting others to zero if you achieve an undetectable viral load with antiretroviral therapy.


Current evidence suggests that ex-semen can transmit HIV. To reduce your risk of infection, if you do not have HIV, you can take HIV preventive medicine (PrEP), or start antiretroviral therapy and maintain an undetectable viral load.

Can I stop using condoms if I’m on PrEP?


Pulling out before ejaculation does not prevent the transmission of HIV. The HIV level in semen is about the same as in semen. Also, even the amount of fluid, which tends to be small, may be enough to cause an infection. Factors such as a high viral load, having a sexually transmitted infection, or having anal sex can increase the risk.

If you do not always use external or internal condoms, consider starting pre-exposure (PrEP) to reduce your risk of contracting the virus. If you are infected with HIV, you can significantly reduce the risk of transmission by continuing to use antiretroviral therapy and maintaining an undetectable viral load.

VigorTip words

If you are concerned that you have HIV, don’t wait to get tested. Instead, go to the nearest clinic and ask for post-exposure prophylaxis (PEP). This is a strategy in which antiretroviral drugs are taken for 28 days after exposure to avoid HIV infection.

PEP needs to be started within 72 hours of possible exposure, preferably within 48 hours. Take a quick HIV test beforehand to make sure you don’t have HIV. Another HIV test is then done to see if infection has been prevented.

Frequently Asked Questions

  • How can you help prevent HIV transmission?

    There are several key ways to avoid HIV, including limiting the number of sexual partners, using external or internal condoms each time you have sex, and avoiding needle sharing. If you are HIV positive, it is important to take your medicines correctly to keep your viral load undetectable. Your partner can also take PrEP to reduce the risk of HIV infection.

  • How is HIV treated?

    HIV is treated with antiretroviral drugs. Lifestyle changes can also keep you strong and help you avoid infections. This includes quitting smoking, eating healthy, exercising regularly, and getting regular HIV tests.

    understand more:

    How to treat HIV

  • What are the symptoms of HIV?

    Symptoms of HIV vary by stage.

    • In stage 1 (acute HIV), symptoms may include fever, chills, headache, night sweats, sore throat, fatigue, and swollen lymph nodes.
    • In stage 2 (chronic HIV), there may be few, if any, noticeable symptoms.
    • In stage 3 (AIDS), symptoms can be severe and include weight loss, dementia, and potentially life-threatening opportunistic infections.