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More than 65% of women of childbearing age use some form of birth control, according to the CDC. If you belong to this age group, you may know about various birth control methods, such as male or female condoms, birth control pills, IUDs, patches, shots, implants, and vaginal rings. But you may not know about a new option: a birth control gel, called Phexxi.
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What is Phexxi?
Phexxi is a birth control gel approved by the United States Food and Drug Administration (FDA) in May 2020. A prescription medication, Phexxi contains the active ingredients lactic acid, citric acid, and potassium bitartrate. Unlike traditional birth control, Phexxi does not contain hormones. (Birth control pills and many other forms of birth control are hormonal contraceptives.)
How does Phexxi work?
Phexxi works by lowering the vagina’s pH, making it difficult for sperm to survive and reach the egg. The normal range of the vagina’s pH level is 3.5 to 4.5. Usually, when sperm enters the vagina, it raises the vagina’s pH, and the sperm is able to travel to the egg. But Phexxi keeps the vaginal pH between 3.5 to 4.5, which lowers the chance of the sperm reaching the egg by decreasing sperm motility.
Evofem Biosciences manufactures Phexxi, and there is currently no generic available.
What are the benefits of hormone-free birth control?
Birth control containing the hormone estrogen can increase your risk of blood clots, stroke, and high blood pressure, and has been linked to increased risk of breast cancer and ovarian cancer. With hormone-free birth control, such as Phexxi, you won’t experience any of the side effects common with such contraceptives (nausea, headache, breast tenderness, weight gain, irregular bleeding, acne, mood changes, and decreased libido).
Non-hormonal birth control such as condoms offer protection from sexually transmitted infections like gonorrhea and chlamydia that hormonal options don’t protect from. Though they don’t protect you from STDs, non-hormonal IUDs can be used long-term—for 3-12 years.
How do I use Phexxi?
Phexxi was designed to be placed inside the vagina right before sex (or up to one hour before) and lasts up to an hour. Each prefilled applicator contains one, 5-gram dose. If you use it as prescribed—inserting a second dose only if an hour has passed with no vaginal sex—there is no risk of overdose.
To use Phexxi, insert the included plunger rod into the prefilled applicator, removing the cap. Next, place the applicator—as far as you comfortably can—into your vagina, using the plunger to release its contents. Finally, you’ll remove the applicator—it’s okay if there’s a small amount of the vaginal gel remaining inside of the device.
If you are considering Phexxi for the prevention of pregnancy, ask your healthcare provider for more information.
When should I use the birth control gel?
Phexxi only works when used before sexual intercourse—it will not prevent pregnancy if you use it after engaging in vaginal sex. If you have sex more than once within one hour, you must use an additional dose of Phexxi. And if vaginal intercourse does not occur within one hour, apply an additional dose.
Phexxi can be used with other contraception forms, including birth control pills, condoms, and diaphragms, but it cannot be used with vaginal rings, such as NuvaRing. You can use Phexxi during any part of the menstrual cycle.
How effective is Phexxi?
In clinical trials, Phexxi was tested for seven menstrual cycles and was about 86% effective at preventing pregnancy. Almost 14% of women got pregnant during that time. Following the instructions precisely will decrease your chances of getting pregnant.
You may be wondering if Phexxi is more effective than condoms. The answer is, it depends. With ideal use, condoms are 98% effective, but not everyone uses condoms perfectly every time. In real life, they are 85% effective at preventing pregnancy, slightly less so than Phexxi.
Is Phexxi safe?
In rare cases, Phexxi may cause bladder or kidney infections; in clinical trials, these conditions were reported at a rate of 0.36%. People with a history of urinary tract problems should not use Phexxi. It’s also important to note that this contraceptive does not protect against STDs, and should be avoided if you or your partner is allergic to citric acid, lactic acid, or potassium bitartrate. If you develop any serious side effects or an allergic reaction, stop use of the product and get emergency medical carer.
Phexxi side effects
The most common side effects of Phexxi are local side effects—burning and itching around the vulva and vagina.
Other possible side effects include:
- Vaginal yeast infections
- Bacterial vaginosis
- Urinary tract infections
- Genital discomfort
- Vaginal discharge
- Pain when urinating
The male partner may also experience local mild side effects, such as a burning or itching sensation.
If you experience urinary tract symptoms or you or your partner experience uncomfortable side effects, notify your healthcare provider. A recent Stage 3 clinical trial by Evofem Biosciences showed that Phexxi users had fewer urinary tract infections than the general population. Further research is needed to find out if Phexxi impacts the incidence of UTIs in women.
Phexxi should be avoided by those with a vaginal ring. There are no known reactions between Phexxi and alcohol, and there are no known drug interactions with Phexxi at this time. Consult with your provider to discuss any medications you are taking.
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What’s the difference between Phexxi gel, spermicide, and vaginal contraceptive film (VCF)?
Phexxi is not the only type of vaginal contraceptive; there are also spermicides and vaginal contraceptive films. These three methods do share one similarity: They do not protect against sexually transmitted infections (STIs such as HIV, chlamydia, gonorrhea, syphilis). However, there are many ways the three differ.
Phexxi
Phexxi is a non-hormonal contraceptive gel that requires a prescription. It lowers the vagina’s pH to a more acidic environment, making it difficult for sperm to survive and reach the egg.
- Prescription only
- Effectiveness: It is about 86% effective with typical use.
Spermicide
Spermicide is a substance that kills sperm when sperm comes in contact with it. Traditional spermicides can be found in the forms of jelly, cream, foam, suppositories, and film. Most spermicides contain nonoxynol-9. Depending on the formulation, you will insert the spermicide with your finger or an applicator at the instructed time before intercourse.
- Spermicides are available over the counter (OTC).
- Using spermicides alone is not recommended because this method is only about 71% effective.
VCF
VCF (vaginal contraceptive film) is a soft, dissolvable square of film that contains the FDA-approved spermicide nonoxynol-9. VCF is manually inserted into the vagina at least 15 minutes before sexual intercourse. The film dissolves, creating a gel coating of spermicide, which kills sperm for up to three hours.
- VCF is available OTC.
- VCF can be up to 94% effective when used as primary birth control, with perfect use.
Who should not use Phexxi?
Although Phexxi can be used with other birth control methods, or with vaginal fungal infection treatment, it should not be used in combination with a vaginal ring, such as NuvaRing.
Females with a history of urinary tract infections or abnormalities should discuss the risks of Phexxi with their healthcare provider. Phexxi can cause cystitis (bladder infection), pyelonephritis (kidney infection), and other types of urinary tract infections.
Phexxi should not be used for prevention of pregnancy after intercourse. It should only be used before intercourse, as instructed. It does not protect against STIs.
It is not known whether Phexxi passes into breast milk, so consult with your provider if you are breastfeeding.
What are the pros and cons of Phexxi?
Pros of Phexxi:
- Side effects are usually limited to the local/vaginal area.
- May be covered by insurance (depending on the plan).
- Phexxi does not contain hormones (such as estrogens or progestins).
- No need to remember to take pills—can be used as needed before intercourse.
Cons of Phexxi:
- Phexxi is not as effective as other methods of birth control.
- Phexxi does not protect against sexually transmitted infections.
- Some side effects may be bothersome.
- Patients with urinary tract infections or problems may not be able to use Phexxi.
How to get Phexxi birth control gel
Phexxi is available by prescription. If you think Phexxi may be a good contraceptive option for you, talk to your women’s health provider about family planning and birth control options. If your healthcare provider determines Phexxi is appropriate for you, they can issue a prescription for Phexxi.
How much does Phexxi cost?
Phexxi may not be covered by your health insurance. Without insurance, Phexxi costs $374 for 12, 5 gm of 1.8-1-0.4% gel*. You can save money on your prescription with a SingleCare coupon.
RELATED: How much does birth control cost yearly?
*Prescription prices change frequently. Search for Phexxi on singlecare.com for current prices before you go to the pharmacy.
Phexxi reviews
Phexxi has FDA approval, so it’s absolutely legit, says Amy Roskin, MD, a board-certified OB-GYN and Chief Medical Officer at Seven Starling, a women’s health digital platform. “I would recommend Phexxi, especially to augment or add to a current birth control regimen,” Dr. Roskin says.
It’s also a good option for women who can’t tolerate hormonal birth control, says Andrea Martin, DNP, WHNP, CRNP, a sexual medicine nurse practitioner in Rockville, MD. Many of Martin’s patients can’t use most hormonal birth control options because of side effects like vulvar pain and decreased libido. “I had a patient that has intense vulvar pain and won’t be able to restart birth control. We discussed Phexxi and she was happy to find a non-hormonal method that she can easily use,” Martin says.
The bottom line? When used properly, Phexxi is an effective form of birth control.
