You might think that most forms of birth control used by women would contain hormones. think again
A non-hormonal birth control option called Phexxi, manufactured by Evofem Biosciences, was approved by the FDA in 2020. One of the product’s commercials takes place in the vagina (yes!) of Schitt’s Creek actress Annie Murphy. The ad is set up to look like a luxurious bedroom with Murphy lounging around waiting for, um, fun.
How does Phexxi work? Well, Phexxi prevents pregnancy by changing the pH of the vagina. A healthy vaginal pH is between 3.8 and 4.5. When a couple is trying to conceive, sperm enters the vagina and raises the pH of the vagina, making it a more hospitable environment for sperm. This makes it easier for the sperm to enter the cervical canal and potentially lead to pregnancy.
Phexxi is a gel containing lactic acid, citric acid and potassium bitartrate. When Phexxi is used in the vagina, it keeps the vaginal pH in the acidic range. This helps prevent sperm from traveling to the cervix and then to the uterus to reach an egg.
“The sperm never reach the egg to fertilize it because they can’t get through the vagina,” says Dr. Megan Gray, an ob/gyn at Orlando Health Physician Associates in Orlando, Florida.
Phexxi users insert the gel into the vagina via an applicator up to one hour before planned sexual intercourse.
This form of non-hormonal birth control is available by prescription. Without insurance, Phexxi costs about $270 for 12 applicators. Each applicator has a use. There are some discount vouchers for privately insured people on the manufacturer’s website. Costs vary if you have insurance.
When used perfectly – meaning always used before sex and within that one-hour window – Phexxi’s effectiveness rate is 93%. When not used perfectly, it’s 86% effective, according to Planned Parenthood. In other words, 14 out of 100 users would get pregnant with Phexxi and no other birth control methods.
You can increase the effectiveness of Phexxi by using other birth control methods such as condoms or a diaphragm.
- Most effective: A contraceptive implant, IUD, or sterilization. In 100 women, these methods result in less than one pregnancy per year.
- Average effectiveness: A contraceptive shot, pill, or patch; a vaginal ring or diaphragm. These methods result in 6 to 12 pregnancies for every 100 women who use them, according to ACOG.
- Lowest effectiveness: A male condom, a female condom, a cervical cap, a sponge, fertility awareness based methods and a spermicide. These are associated with 18 or more pregnancies in a year for women who use them.
Who wants to use Phexxi?
One benefit of Phexxi is that it increases the number of birth control options available, says Dr. G. Thomas Ruiz, OB/GYN director at MemorialCare Orange Coast Medical Center in Fountain Valley, California. But that doesn’t mean it’s for everyone.
Phexxi may appeal to women who want to avoid hormonal birth control. There are a number of reasons why this is important to you:
- They find that hormonal birth control has uncomfortable side effects for them, like mood swings, unpredictable bleeding, and reduced libido, says Dr. Chidera Ejiogu, ob/gyn at UTHealth Houston and Memorial Hermann Hospital.
- You can’t use hormonal birth control because of another medical condition, like high blood pressure or blood clots, says Dr. Rachel Jensen, a resident of the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Maryland School of Medicine in Baltimore. Hormonal birth control can increase the risk of high blood pressure or blood clots. According to the National Blood Clot Alliance, one in 3,000 women taking birth control pills will develop a blood clot annually. That may be a relatively small number, but it puts women who are already prone to blood clots at even greater risk.
- You want to take a break from hormonal birth control like the pill. There is no medical reason for this, but Ruiz has a few patients who have expressed this preference.
- They smoke. Smoking and using hormonal contraceptives can increase the risk of blood clots.
Here are some patients that Phexxi might be a good choice for them:
- A woman in her 40s who smokes and has a long-distance partner who she sees occasionally. It could also be that she or her partner doesn’t like condoms. dr Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive services at Yale University in New Haven, Connecticut, considers this individual a potential Phexxi user because she has a reduced (though not zero) chance of conceiving become the old age. Also, she shouldn’t take birth control pills because she smokes.
- A new mother who is breastfeeding. At the same time, that person would be OK with an unplanned pregnancy, Minkin says. According to the package insert, it is not known whether Phexxi passes into breast milk. However, according to the OB/GYN interviewed for this article, it appears to be safe for this patient population.
- A woman who may not be able to use other forms of birth control. For example, she dislikes IUDs due to cramps and would like to avoid hormonal contraceptives such as the pill.
- A woman who is taking birth control pills and wants to add another type of protection against pregnancy. “However, most people who are attracted to this contraceptive want to avoid hormones,” Gray points out.
Who should avoid Phexxi?
Women who are not ideal for Phexxi are those who:
- Would you also like protection from sexually transmitted infections. Condoms are the only birth control method that protects against both pregnancy and STIs.
- Do you have frequent urinary tract infections or do you have urinary tract or kidney disease. Phexxi’s packaging advises women with urinary tract or kidney disease to avoid Phexxi. This is due to the low probability that more urinary tract infections or kidney infections could occur while using the product.
- Would strongly oppose getting pregnant.
- May forget to use Phexxi in the one hour window before sex.
- You want to continue using a vaginal ring. While Phexxi can be used at the same time as certain other birth control methods, such as condoms, it cannot be used at the same time as a vaginal ring, Jensen says. This is because vaginal rings are typically made from flexible silicone rubber that has contraceptive hormones embedded in it. The Phexxi gel would break down the silicone material, Ruiz explains.
Non-hormonal birth control options
While it may be the only non-hormonal birth control gel, Phexxi is not the only form of non-hormonal birth control available. Other options are:
- copper spiral. This type of IUD is different from the standard IUDs that contain hormones. However, some women don’t like copper IUDs because they make their periods heavier, Ruiz says.
- cervical caps. This is a small cap, shaped like a sailor’s hat, that is inserted deep into the vagina to cover the cervix and prevent pregnancy.
- condoms, including male condoms and female condoms.
Phexxi side effects
Like any form of birth control, Phexxi comes with some side effects. These side effects are not common, but they include:
- Burning and irritation where the gel is inserted. This occurs in about 2% of patients.
- Bacterial Vaginosis.
- pain when urinating.
- Vaginal discharge.
- A yeast infection.
Occasionally, the male partner may also experience genital burning or discomfort from Phexxi.
More serious side effects, such as urinary tract infection or kidney infection, occur in about 0.36% of users.
If you think you’re having an allergic reaction to Phexxi, see a doctor right away, Ejiogu warns. Signs of an allergic reaction are:
- irritation where inserted.
- loss of consciousness.
- Shortness of breath.
Some final remarks
Here are some final reminders when considering Phexxi as a birth control option:
- If you plan to have sex after the first hour window, or if you are about to have sex again, you will need to reinsert the gel.
- Phexxi should not work outside of the initial one-hour window.
- You can continue to use Phexxi during your period.
- If you have sex more than once in an hour, you will need to reinsert Phexxi.
- It doesn’t work if used after sex.
- It’s okay to use Phexxi along with other vaginal medications to treat yeast infections.
- Phexxi does not protect against STIs such as HIV, hepatitis, syphilis and others.
- You can use Phexxi with other birth control methods, including condoms and the pill. However, do not use it while using a vaginal ring at the same time.