In September 2020, a new type of non-hormonal birth control called Phexxi launched after it was approved by the US Food and Drug Administration (FDA). Since then, it's popped up in TV and social media ads, heavily targeting younger women who want birth control but are wary of putting hormones in their body.
But Phexxi has quietly flown under the radar for a bit, and only a small number of women have tried the drug so far. Evofem Biosciences, the company that makes Phexxi, shared in a press release in March that it sold more than 2,400 units of the contraceptive in February, which was a 30% increase over the previous month. Monthly prescriptions also grew 32% to 2,349, the company said. By comparison, 6.6 million women in the US are on the Pill, according to the Centers for Disease Control and Prevention (CDC).
Because it's still so new, many women may not know much (or anything at all) about Phexxi, how it works, or who might benefit most from the medication Here are the basics, including how Phexxi differs from other forms of birth control, and when you might want to ask your doctor about it.
What is Phexxi and how does it work?
Phexxi is a prescription-only, non-hormonal form of birth control (meaning a method of birth control that doesn't affect a woman's hormones). It's a gel that contains lactic acid, citric acid, and potassium bitartrate.
It's pretty easy to use-just insert a pre-filled applicator into your vagina immediately before or up to an hour before you have vaginal intercourse. If you're having sex more than once within an hour, or if you end up waiting more than an hour before sex, you may need an additional dose.
Phexxi works by altering the pH of your vagina to make it more acidic and less hospitable to sperm. As a result, it's much less likely that sperm will actually make it to your egg to cause a pregnancy. "Sperm thrive in an alkaline environment," women's health expert Jennifer Wider, MD, tells Health. "If the pH of the vagina is too acidic, the sperm will not be able to swim well or potentially die off."
How effective is Phexxi compared to other forms birth control?
According to data cited by the FDA, Phexxi is about 86% percent effective with typical use. (With perfect use, that number rises to 93% effective, according to Planned Parenthood-but perfect use with any form of birth control is rare). Planned Parenthood says this means about 14 in 100 women who use Phexxi (again, with typical use) will become pregnant.
That's much less effective than the implant, an IUD, or male or female sterilization, which has about a 99% effectiveness, per the CDC. Even with typical use the patch, the ring, the shot, and the Pill-which range from 91%-94% effective-are all also more effective than Phexxi.
Instead, the new birth control method is more on par with other non-hormonal methods like male and female condoms, diaphragms, spermicides, and the sponge, at preventing pregnancy. Worth noting: The CDC calls these methods "less effective" than their counterparts.
Planned Parenthood also says you can (and possibly even should) use Phexxi with plastic or latex condoms for extra protection against pregnancy as well as STDs. Phexxi can also be used with a diaphragm as well as some other types of hormonal contraceptives, like the patch, Pill, or shot. You should not, however, use Phexxi with a vaginal ring.
Who is Phexxi best for?
"Phexxi is great for those who are looking for contraceptive alternatives, don't desire hormones, and are possibly not sexually active consistently," Jessica Shepherd, MD, ob-gyn, CEO and founder of Sanctum Med Wellness, tells Health. Phexxi can be a good fit for women who aren't interested in taking a daily pill or using a long-acting form of birth control like an implant, IUD, or ring, she says.
Phexxi may also be an important choice for women who can't use hormonal forms of birth control. "Not every woman can use a hormonal birth control-women who are at risk for blood clots, hormone-driven cancers like certain forms of breast cancer and other gynecological cancers may be advised to use a non-hormonal method," Dr. Wider says.
For women who use lifestyle methods-like fertility awareness of the withdrawal or "pull-out" method-Phexxi may be a good addition to their routine, Julie Levitt, MD, an ob/gyn at The Women's Group of Northwestern, in Chicago, tells Health. "At worst, it's 86% effective, but it could be much better if women are watching their cycle," she says.
There's also this to consider, Dr. Wider says: "Non-hormonal methods would likely eliminate some unwanted side effects that women can experience on hormonal birth control like mood swings and weight gain." So if a woman is especially concerned about any of those things, she and her doctor may consider Phexxi.
Does Phexxi have any side effects or risks?
According to the FDA, the following symptoms or conditions are listed as potential side effects of using Phexxi:
- Vaginal burning
- Vaginal itching
- UTI
- Vulvovaginal discomfort
- Yeast infection
- Bacterial vaginosis
- Vaginal discharge
- Genital discomfort
- Pain when you pee
- Vulvovaginal pain
Phexxi isn't perfect, and experts are particularly concerned about the 86% effectiveness. "It doesn't give ideal contraception, so if you are going to be having frequent intercourse-and particularly if you are a young fertile woman-I would suggest speaking with your health care provider to get a more effective contraceptive," Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells Health.
There are non-hormonal birth control options that are more effective, Dr. Minkin says, like the Paragard IUD, which uses copper (which creates a toxic environment for sperm) instead of hormones. "It gives them 99% effective contraception, has no hormones, and lasts for at least 10 years," she says.
The side effects can also make Phexxi a less-than-ideal choice for some women. "Women prone to urinary tract infections or recurrent yeast infections should definitely check in with their doctor," Dr. Wider says.
Overall though, Phexxi adds one more birth control option to the table for women, which is never a bad thing. "It's a great addition for women who are seeking non-hormonal methods," Dr. Wider says. And when more options are available, more women may use them to prevent pregnancy. As Dr. Levitt says: "Anything is better than nothing."
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