Outside of in vitro fertilization and similar approaches, it’s possible to get pregnant without having penetrative sex, but this is extremely rare.

Do you remember hearing about that friend of a friend who got pregnant just by kissing in a hot tub? While that ended up being an urban legend, you may be surprised to learn you actually can get pregnant without having penetrative sex.

Here’s more about how fertilization happens, what sexual activities may result in pregnancy, and what you can do if you think you’re pregnant or want to avoid pregnancy entirely.

The answer is — yes! While it isn’t likely, any activity that introduces sperm to the vaginal area makes pregnancy possible without penetration.

To understand how, let’s consider how pregnancy usually occurs. The process is typically pretty straightforward. For pregnancy to occur, one sperm (from a male’s ejaculate) must meet one egg (inside a female’s fallopian tubes).

Once the egg is fertilized, it must travel and implant into the lining of the uterus. Having penis-in-vagina sex helps deliver ejaculate closest to the cervix so that millions of sperm can make the journey to fertilization.

There’s just one catch: An egg cannot be fertilized until it’s released from the ovary. This typically happens once a month — approximately 14 days before the next menstrual period — during ovulation.

Around the time of ovulation, a woman’s cervical mucus thins and becomes more egg-white-like to allow the sperm to swim more freely. The texture is similar to that of the secretions that are produced during arousal. These fluids flow throughout the vaginal canal and into the opening of the vagina.

Any sexual activity that introduces sperm into — or around — the vagina could result in a sperm making its way to the egg.

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Even before a male fully ejaculates, he may produce sperm in pre-ejaculate (pre-come) fluid. To give you some numbers, one milliliter of ejaculate contains between 15 to 200 million sperm. And a recent study shows that 16.7 percent of men have active sperm in their pre-ejaculate as well.

Specific counts vary per ejaculate and by individual, but you get the idea — that’s a lot of little swimmers. And to get pregnant, it takes just one.

If ejaculate or pre-ejaculate come into contact with the vaginal area, though chances are small, it’s possible pregnancy may occur. Keep in mind these fluids can be transferred to the area via toys, fingers, and mouths — not just penises.

Do ‘virgin pregnancies’ really happen?

Researchers have studied a phenomenon called “virgin pregnancy” to understand why it would be reported. In a survey of 7,870 pregnant women, they discovered that 0.8 percent of the women (45 total) reported becoming pregnant without having vaginal sex.

A study like this has limitations, as it involved self-reporting. The researchers noted various cultural and religious expectations in the mix (like chastity pledges and lack of sexual education), as well as varying definitions of what “sex” meant. As such, these numbers don’t represent a true picture of the frequency of fertilization without penetration.

Regardless, it’s likely that some of these women may have defined “sex” as penis-in-vagina sex. So, if the virgins in the study had other sexual contact, it’s possible that sperm somehow made its way up the vaginal tract from other acts.

Are there other ways to get pregnant without having sex?

Interestingly, this study also brings up artificial reproductive technology (ART). While the women in this study did not engage in any ART procedures, it’s possible to get pregnant without ever having penetrative sex through procedures like intrauterine insemination (IUI) and in vitro fertilization (IVF).

While this option works for those who require donor sperm or eggs, such as same-sex couples, it’s also an option for those for whom engaging in intercourse is either not desired or impossible.

Related: 27 things you should know before you “lose” your virginity

If your period is late or you’re having other early pregnancy symptoms, it’s a good idea to take a home pregnancy test.

Signs of pregnancy include things like swollen or sore breasts, frequent urination, nausea with or without vomiting, and tiredness. You may also experience less common or even strange symptoms, such as constipation, a metallic taste in your mouth, or dizziness.

There are several different types of pregnancy tests, including home kits that test urine for the presence of human chorionic gonadotropin (hCG). You can pick one up at most pharmacies or grocery stores or even online.

Home tests range in sensitivity, so a negative result doesn’t always mean you aren’t pregnant. If you get a negative result and still suspect you might be pregnant, consider taking another home test in a few days.

As a general rule of thumb, you may want to wait until after your missed period to test. By that time, there’s usually enough hCG in your system to be detected by most tests. However, some tests may give you a positive result as early as 4 or 5 days before your expected period.

Still not sure? Try making an appointment with your primary care provider. They can test your urine in the office setting for hCG. Beyond that, your doctor may also give you a blood test that can tell you the exact level of hCG circulating in your body (the higher the number, the farther along you possibly are).

Related: When you should take a pregnancy test

There are many ways to prevent pregnancy — even without a prescription.

Over-the-counter options

Many options are readily available. For example, male condoms are easy to find and relatively inexpensive. (In fact, you may be able to get them for free at your local health center, like Planned Parenthood.)

They are around 82 percent effective at preventing pregnancy without the use of any additional method. Bonus: Condoms also protect against sexually transmitted infections (STIs), which can be transmitted via any type of skin-to-skin contact.

Other over-the-counter (OTC) options (and their effectiveness) include the female condom (79 percent) and the contraceptive sponge (76 to 88 percent). All OTC methods are most effective when used with a spermicidal lubricant, which kills or immobilizes sperm.

There are also emergency contraceptive options available over the counter.

Prescription methods

You may also want to make an appointment to speak with your doctor about other forms of birth control.

  • Birth control pills. There are several types of birth control pills. Some contain only progestin (mini pill) while others contain a mix of progestin and estrogen (combo). The pill is taken daily and can be up to 91 percent effective. However, with imperfect use, 6 to 12 percent of women may get pregnant each year.
  • Diaphragm. You’ll need a prescription as most diaphragm models need to be fitted for your body, although there’s a newer option that does not. They’re considered 88 percent effective. (Learn more…)
  • Patch. Like birth control pills, the patch uses hormones to prevent pregnancy. It’s applied weekly and as effective as birth control pills.
  • Vaginal ring. The ring is inserted into the vagina each month to deliver hormones to prevent pregnancy. It’s similar in effectiveness to both the pill and patch.
  • Intrauterine device (IUD). An IUD is a small device that a doctor inserts into the vagina. It can block sperm from reaching the egg, and certain types may also thicken the cervical mucus using hormones. Lasting 3 to 10 years (depending on the type), this method is 99 percent effective at preventing pregnancy.
  • Implant. A Nexplanon implant is a rod that’s inserted into the arm, and it produces the hormone progestin for up to 3 years. It’s around 99 percent effective at preventing pregnancy.
  • Birth control shot. The Depo-Provera shot is made of the hormone progestin and effective for 12 to 15 weeks. It may guard against pregnancy up to 94 percent of the time. However, with “typical” use, around 6 to 12 percent of women will get pregnant each year.

Other methods

Fertility awareness (also called the rhythm method) relies on the menstruating partner knowing their menstrual cycle intimately and timing sex so that it does not fall within the fertile window.

This means you’ll need to track your basal body temperature, cervical fluid, and other signs and avoid sex in the days before and on ovulation. This method doesn’t require medications, and many like the simplicity. However, it’s only 76 percent effective.

Abstinence is another option, but it may mean different things to different people. True abstinence from oral, vaginal, and anal sex is 100 percent effective if you don’t engage in any type of activity that deposits sperm in or around the vagina. You may have a lot of questions about abstinence, so here are some answers to nine of the most frequently asked questions.

Bottom line: What you ultimately choose is up to you. Think about your goals, speak with your partner, and consider making an appointment with your healthcare provider to chat about the options. You may want to try different methods until you find something that works for both your body and your lifestyle.

Related: Which birth control method is right for you?

Getting pregnant without vaginal sex may seem unlikely. However, when you’re in a physical relationship that involves a partner with a uterus and ovaries and partner producing sperm, it’s possible.

If you aren’t looking to become pregnant anytime soon, take some time to survey your birth control options or make an appointment with your doctor. No matter what type of sex you’re having, be sure to practice safe sex and use tools like condoms to protect yourself from STIs.