If you’re on the hunt for a new birth control method, you’re in luck — many new options have recently come to the market or are slated to be released soon. One of them is Phexxi, a non-hormonal, on-demand vaginal contraceptive gel that was approved by the FDA in May of 2020.
You may have come across ads for Phexxi, so let’s break down how it works and if it’s worth bringing up with your doctor!
How does Phexxi work?
First thing’s first, Phexxi isn’t a spermicide. Spermicides can be purchased over the counter, and their active ingredient (nonoxynol-9) slows sperm down or kills it, making them less likely to reach an egg.
Phexxi, on the other hand, requires a prescription. It’s non-hormonal and its active ingredients are lactic acid, citric acid, and potassium bitartrate. It works by keeping the vagina acidic. Getting a prescription to keep something the same may not seem like it makes a lot of sense, so let’s take a quick anatomy and reproductive biology detour to explain why.
The vagina is naturally moderately acidic; its pH ranges from 3.8 to 4.5. Semen, on the other hand, is slightly alkaline — its pH typically ranges from 7.2 to 8.0. Sperm can’t really handle the naturally acidic nature of the vagina (its optimal environmental pH is 7-8.5), and if the vagina were always acidic, people wouldn’t be able to get pregnant very easily.
Enter Luteinizing Hormone (LH). When LH is released, the ovaries release an egg and slightly increase the vagina’s pH by altering vaginal secretions. Semen itself also can temporarily raise the vagina’s pH. During ovulation, cervical mucus becomes thinner, clear, and stretchier (like egg whites), which is more friendly to sperm — this is part of why vagina-owners are more fertile during certain days of their menstrual cycle. Hormonal birth control options make cervical mucus stay thicker and less sperm-friendly (and some suppress ovulation, too).
Okay, back to Phexxi. Phexxi is a gel that is inserted into the vagina up to one hour before vaginal sex happens. It works by keeping your vagina acidic and making it a really unpleasant and unviable environment for sperm. So, while it has a similar effect on sperm as spermicides, it achieves that goal in a different way.
Phexxi is safe to use with pretty much every form of birth control, except for vaginal rings.
It’s worth noting that Phexxi doesn’t protect against any STIs and isn’t effective at pregnancy prevention when used after sex. However, Phexxi can be used with most other methods of birth control, which is pretty nifty!
Phexxi is safe to use with pretty much every form of birth control (including most condoms and diaphragms), except for vaginal rings. So, if you already use Nuvaring or Annovera, you shouldn’t use Phexxi, too. Phexxi’s prescribing information only mentions polyurethane, latex, and polyisoprene condoms — not nitrile or natural membrane — so if you use those, talk with your doctor before using Phexxi.
Who is Phexxi best for?
Phexxi is considered an on-demand birth control, meaning you only use it when you need it. If you’re someone who isn’t interested in an ongoing hormonal method of birth control (like the pill or a ‘set-it-and-forget-it’ method), then Phexxi could be a good option for you to consider.
And one helpful note: Because Phexxi is non-hormonal, it could be a good option for transmasculine folks who are taking testosterone. Folks who take testosterone have traditionally been limited in the contraceptive market (FYI, taking testosterone doesn’t mean you can’t get pregnant), and often have to turn to IUDs or barrier methods in order to have minimal cross-effects between their birth control and their hormone replacement therapy.
So, Phexxi could be a good option here, as long as someone is comfortable interacting with their front hole and is aware of the potential side effects. While this hasn’t been studied, I would also recommend that folks who take testosterone exercise additional awareness of front hole pain or discomfort — taking testosterone can cause vaginal dryness and atrophy, and the acidic quality of Phexxi could cause additional irritation.
If you are someone who has had recurrent UTIs, Phexxi is not for you.
However, Phexxi isn’t for everyone. It has to be inserted vaginally before sex happens, so if you’re forgetful or someone who is really anxious about “interrupting” sex to use your birth control, this wouldn’t be the best option.
Phexxi is also only effective for one act of vaginal sex. So, if in one night you have penis-in-vagina sex three times, you would need to use three separate doses of Phexxi. One box only comes with 12 doses, so if you’re someone who is into marathon sex or loves pulling sexy all-nighters, this probably wouldn’t be the best option for you, either. And, if you are having sex at your partner’s home, you would have to bring your doses with you (just like you might plan to bring condoms).
Here’s the big note: If you are someone who has had recurrent UTIs or other urinary tract issues, Phexxi is not for you and shouldn’t be prescribed. That’s because folks with recurrent UTIs or other urinary tract concerns may be more likely to develop bladder, kidney, or urinary tract infections.
What’s it like to use Phexxi?
Phexxi is a gel that is inserted into the vagina, but you don’t have to use your fingers for it — each dose comes individually wrapped and pre-measured in an applicator. Inserting it is pretty similar to inserting a tampon with an applicator. You can insert Phexxi up to an hour before vaginal sex begins, but you have to use a new dose for each instance of penis-in-vagina sex.
If you’re someone who has used a gel spermicide or even used an applicator to apply lube vaginally, then the sensation of Phexxi will be pretty familiar. You’ll likely notice the gel, especially for the first few minutes. After sex, it’ll slowly be expelled from your body along with any vaginal fluids, semen, or lubricant.
Now for some of the more common side effects.
Across two clinical trials of Phexxi, 18% of folks experienced vulvovaginal burning and 14.5% experienced vulvovaginal pruritis (a fancy word for itching). Some folks also experienced yeast infections and bacterial vaginosis, though at lower rates. Partners who had penises also experienced some side effects — 9.8% experienced feelings of genital discomfort (like burning or itching) after using it.
Ultimately, Phexxi’s cost is going to depend on if you have health insurance.
So pay close attention to you and your partners’ bodies. Are you noticing any side effects? How quickly do they resolve, and do you have to do anything to help them resolve? You shouldn’t need to suffer through your birth control method, so be honest about how you’re feeling and if you want a different method, chat with your doctor.
How effective is Phexxi?
When we talk about birth control efficacy, there are two measures to keep in mind: the efficacy rate with perfect use, and the efficacy rate with typical use.
“Perfect use” means that you follow the instructions exactly as they’re written and you never forget a step or a dose. “Typical use” means that you’re human and sometimes you forget things (like to insert Phexxi before sex starts).
With perfect use, Phexxi could be up to 93% effective. However, trial data and typical use puts Phexxi at around 86% effective at preventing pregnancy. To put it into perspective, condoms are 86% effective with typical use (but 97% effective with perfect use).
Remember: Phexxi isn’t effective if you use it after sex, and if you have penis-in-vagina sex more than once in a night or for longer than one hour, you should use a second dose.
How much does Phexxi cost?
Ultimately, Phexxi’s cost is going to depend on if you have health insurance and what types of birth control your insurance covers.
The Affordable Care Act (ACA) requires insurance companies to cover at least one form of birth control in each category. Many insurance companies hesitate to include coverage for new forms of birth control, so your insurance may not cover it, but you should check with them to see. There also isn’t a generic version of Phexxi, which means the price will remain high for a while.
According to GoodRx, Phexxi’s cash price at the pharmacy ranges from $318 to $324 (though you can get a GoodRx coupon to bring the price down to about $30). EvoFem, the company that produces Phexxi, also has a program where you may be able to get Phexxi for $30 a month or less.
Like any other form of birth control, Phexxi won’t be for everyone. It’s more effective if you use it exactly as instructed and use it with another compatible birth control method. However, if you have a history of UTIs or other urinary tract issues, you shouldn’t use it. If you’re curious about it, talk with your doctor!