Spermicide, but better? Our honest review of Phexxi hormone-free birth control

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“Phexxi could be a great BC choice, but ask yourself first if you’re comfortable with the potential side effects.”

What is Phexxi? 

Say hello to more hormone-free birth control options (yes!). The Food and Drug Administration (FDA) recently approved Phexxi—a contraceptive gel that, when applied up to an hour before vaginal intercourse, prevents pregnancy.((Thomas, M. A., Chappell, B. T., Maximos, B., Culwell, K. R., Dart, C., & Howard, B. (2020). A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial. Contraception: X, 2, 100031. https://doi.org/10.1016/j.conx.2020.100031)) Meaning you only have to use it when you’re actually having sex, rather than taking it daily (like the pill) or applying it weekly (like the patch). 

Phexxi is a combo of lactic acid, citric acid, and potassium bitartrate that makes the vagina inhospitable to sperm – i.e. those tiny swimmers die out on contact. It’s recommended as an on-demand form of BC, as opposed to many other options that require a long-term commitment, like the IUD, pill, or shot. 

In fact, Phexxi can even be used simultaneously with hormonal BC, condoms, and diaphragms for that double protection! (No vaginal rings though). Contraceptive gels have been around for a while, and most of the older brands contain nonoxynol-9, or N-9 for short.  Phexxi is different, using an entirely new set of ingredients to get the job done. But is it better? And what’s the difference?

We’ve got you covered: Read on for our honest review of Phexxi, including input from our resident expert, board-certified OB-GYN Dr. Jane van Dis.


Phexxi vs. Nonoxynol-9

N-9, the OG spermicide, works by destroying sperm cell membranes. This is great for preventing pregnancy, but not so much for general vaginal tract health. 

According to Dr. Jane, “studies show that repeated exposure to contraceptive spermicide gels with N-9 increases the risk of bacterial vaginosis.” Bacterial vaginosis is not fun: it can lead to itching, burning, and unpleasant-smelling, grayish or white-ish vaginal discharge

High-dose use of contraceptive gels with N-9 also increases the risk of genital lesions and subsequent STI transmission, and so usage is not recommended for individuals who are at high risk of contracting HIV.((Cahill, E. P., & Kaur, S. (2020). Advances in contraception research and development. Current opinion in obstetrics & gynecology, 32(6), 393–398. https://doi.org/10.1097/GCO.0000000000000666))


How does Phexxi work?

Phexxi differs from N-9 based-contraceptive gels because it uses L-lactic acid, citric acid and potassium bitartrate to maintain an acidic vaginal pH level.((Thomas, M. A., Chappell, B. T., Maximos, B., Culwell, K. R., Dart, C., & Howard, B. (2020). A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial. Contraception: X, 2, 100031. https://doi.org/10.1016/j.conx.2020.100031)) In an acidic environment, sperm cells die off and are unable to fertilize an egg, thus preventing pregnancy.((Zhou, J., Chen, L., Li, J., Li, H., Hong, Z., Xie, M., Chen, S., & Yao, B. (2015). The Semen pH Affects Sperm Motility and Capacitation. PloS one, 10(7), e0132974. https://doi.org/10.1371/journal.pone.0132974))

Researchers found that Phexxi was 86.3% effective in preventing pregnancy as a primary form of birth control.((Thomas, M. A., Chappell, B. T., Maximos, B., Culwell, K. R., Dart, C., & Howard, B. (2020). A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial. Contraception: X, 2, 100031. https://doi.org/10.1016/j.conx.2020.100031))

“Phexxi can also be used in conjunction with other barrier forms of birth control including condoms, diaphragms, and cervical caps,” shared Dr. Jane. Using a combination of a contraceptive spermicide gel and a barrier form of birth control would further reduce the risk of an unplanned pregnancy. 

Another bonus? Phexxi can be used with Flex Disc™ during period sex (but keep in mind that Flex Disc is NOT a contraceptive, so continue to use a different form of backup, like condoms, if you want added protection beyond what Phexxi provides).


How to use Phexxi

Often when we think about contraceptive gels, the words ‘wet’ and ‘slippery’ come to mind – kind of like the slip ‘n slide of BC options. But how the heck are you supposed to get a gel up there far enough to do the job?

The new generation of BC options is here, folks. Phexxi is actually delivered in a vaginal applicator: imagine a tampon, but with gel inside. This allows for a more directed approach, and the manufacturers say that their gel is designed to be bioadhesive, meaning that it’s a low-drip option compared to the older (read: messier) spermicides on the market. 

phexxi contraceptive gel review
Phexxi applicator

Phexxi birth control pros & cons

Phexxi is not for everyone. During trials, commonly reported side effects included “burning” or “itching” in the vulvogainal area, and some participants developed urinary tract infections (UTIs). Due to these side effects, Phexxi is not recommended for people who experience recurrent UTIs or who have urinary tract abnormalities. 

However, most individuals using this contraceptive gel form of birth control reporting being either “satisfied” or “very satisfied” when asked about their experience.((Thomas, M. A., Chappell, B. T., Maximos, B., Culwell, K. R., Dart, C., & Howard, B. (2020). A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial. Contraception: X, 2, 100031. https://doi.org/10.1016/j.conx.2020.100031)) 

In short, Phexxi may be a good birth control option if you are looking for a low commitment option that is kinder to your vaginal tract than a traditional spermicide contraceptive gel.

Here’s a more in-depth look at the pros and cons of Phexxi:

The good:

  • Self-administered. Unlike the IUD or arm implant, Phexxi can be applied without the assistance of a health professional. This makes Phexxi much more accessible, especially for folks who may not be able to make an appointment to see a health care provider. 
  • Non-hormonal. Hormonal birth control options can induce myriad side effects including weight gain, headaches, breast tenderness, mood changes, nausea, and skin changes.((Barr, N.G. (2010). Managing the Adverse Effects of Contraceptives. American family physician, 82(12), 1499–1506.)) Many people are apprehensive about hormonal birth control options because of the potential of side effects to disrupt their daily lives. Phexxi doesn’t rely on changing your hormone levels to function, so users will not experience hormonal side effects. Major win!
  • Flexible. Phexxi is relatively low commitment! No more scheduling pharmacy visits to pick up more birth control pills or yearly maintenance visits to ensure that your IUD has not become dislodged. Those using Phexxi can simply apply the contraceptive gel whenever they are sexually active. 

The bad:

  • Effectiveness. Even when used correctly, Phexxi isn’t as effective as other forms of birth control such as hormonal pills (99%), IUDs (99%), or arm implants (99%).((Contraception. (2020). Retrieved from https://www.cdc.gov/reproductivehealth/contraception/index.htm)) User error, such as having vaginal sex more than an hour after gel application, could further increase the failure rate of Phexxi (more on that below). Some folks might be uncomfortable with the higher failure rate and potential of an unplanned pregnancy – but remember that, with Phexxi, it’s safe to double up and use barrier method contraception, as well. 
  • Timing. Picture this: the playlist is fire, someone’s dimmed the lights, clothing starts to disappear, and… you have to run to the bathroom to insert an applicator filled with contraceptive gel. If this scenario sounds like the ultimate buzzkill, Phexxi may not be right for you. Remember: In order to be effective, Phexxi must be applied a maximum of one hour before sex, so that means you probably can’t apply it before leaving home to head out on your date. 
  • Side effects. No one craves a burning vag. If you are already sensitive to changes in the vaginal environment, you may not want to tempt fate and do anything that disturbs the local climate down there. It’s also a good idea to mention to your partner that you are using Phexxi in case they experience any side effects.
  • Not over-the-counter. Unlike other contraceptive spermicide gels, Phexxi still requires a prescription from a physician or nurse practitioner. While Phexxi is not currently one of the 18 FDA contraceptive methods approved by the Affordable Care Act, Phexxi’s manufacturers are currently working to get it included so that the contraceptive gel will be covered by insurance without deductibles or copays.((Fact sheet: Phexxi Contraceptive Gel. (2020). Retrieved from  https://www.nwhn.org/phexxi/#:~:text=Unlike%20many%20N%2D9%20spermicides,care%20provider%20to%20get%20Phexxi))

Phexxi: The OB/GYN perspective 

Your general practitioner or OB/GYN is a great resource for discussing family planning options and methods. 

When asked what she would tell patients who are considering trying out Phexxi, Dr. Jane says: “[…] it’s great to have options and to know what the possible side effects are, as well, importantly, what the efficacy rate is – the ability of the device or drug to prevent pregnancy.”

“Based on Phexxi’s reported information, 1 in 5 women experienced burning in the vagina with use, and 6 out of 100 reported itching. In addition, 1 in 10 men had burning, itching, or pain. Women [and non-women with uteruses] should also know that, for those using Phexxi over the course of a year, 14 out of 100 will become pregnant.”

Compare this, for instance, to the IUD  – which offers less than a 1 in 100 chance of pregnancy. In other words, Phexxi could be a great BC choice, but ask yourself first if you’re comfortable with the potential side effects (like the itching or burning that could affect you and your partner), as well as its lower efficiency rate than other forms of protection.  


Key takeaways 

Figuring out the best form of birth control is sort of like starting a new relationship— it’s pretty much all about the right fit. And the factors that make a certain BC good for you might be totally different than the factors your BFF is looking for. 

Here’s the main takeaway: Phexxi is the first contraceptive gel of its time to offer short-term spermicide properties with decreased risk of vaginal lesions and bacterial vaginosis. While convenient and flexible, uterus-havers should also consider the side effects before deciding if Phexxi is right for them. 

This article is informational only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.

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