If you’ve ever wished you could have hormone-free birth control only when you need it without having to remember to take a pill every day, then you may be in luck. Phexxi®, an FDA-approved non-hormonal birth control gel, is the first (and only) product of its kind. Whether you’re sensitive to hormonal birth control or looking for a bit more protection on certain days of the month, you'll want to learn more about Phexxi, which is 93% effective when used correctly, per the brand’s website. Romper spoke with two experts, Dr. Charis Chambers, board-certified OB-GYN (who is associated with the brand), and Dr. Lucky Sekhon, fertility specialist and board-certified OB-GYN from NYC, about how Phexxi works, how to use it effectively, and any side effects you should know about.
How Does Phexxi Work?
Phexxi is a gel that gets inserted in the vagina using an applicator, kind of like a tampon. It works by lowering the pH of the vagina. Why does that matter? “These changes in vaginal pH reduce sperm motility and viability,” Dr. Sekhon tells Romper.
Typically, sperm actually raises the pH of the vagina, and by keeping it lower (between 3.5 and 4.5) it greatly reduces the chance of sperm meeting an egg.
While the application may seem similar to that of spermicide, Phexxi and spermicide are not the same. “[Spermicides are ] chemical detergents that attack the sperm heads, damaging sperm cell membranes and thus rendering them unable to fertilize the ovum,” Chambers says. Phexxi’s active ingredients, on the other hand, are lactic acid, citric acid and potassium bitartrate, which help to keep the vagina in its natural acidic state.
How Do I Use Phexxi?
In order for it to work properly, it must be inserted up to an hour before sex. The applicator is pre-filled, so simply unwrap it, insert the plunger into the applicator, take off the pink top, then insert into the vagina. “You use it only when you need birth control – but it must be used either immediately before or anytime up to one hour before every act of vaginal intercourse,” Chambers tells Romper. “If you don’t have sex within the one hour of using Phexxi or if you have sex more than once within that hour, you’ll need to use a new pre-filled applicator. Phexxi is not effective when used after intercourse.” She adds that it is a very viscous liquid so it won't leak out and be uncomfortable or messy.
Why Choose Phexxi?
If you struggle with side effects from hormonal birth control, Phexxi can be a good choice. “Birth control pills may cause bloating, headache, low mood. The IUD in general may cause cramping,” Dr. Sekhon says. She adds that the progestin containing IUD can cause acne, depression, cramps, and irregular spotting/bleeding and the depo provera injection has been associated with weight gain. Many hormonal birth controls contain a black box label, Chambers notes, "which is an FDA warning to alert consumers of potential serious side effects. Phexxi does not have a black box," she says.
If your body doesn’t react well or you don’t like how you feel on more traditional hormonal birth control, Phexxi can be a great option. Just remember that Phexxi does not protect against HIV or STDs, but it's safe to pair with a condom or a diaphragm.
Do I Need A Prescription To Get Phexxi?
In short, yes, Phexxi is a prescription drug much like most birth control pills. However, you don’t have to trek your doctor’s office to get the prescription. You can fill out a questionnaire on the Phexxi website, then you’ll be connected via a telehealth appointment with a board-certified doctor who will ask you questions to determine if Phexxi is right for you; if so, they’ll send the prescription right to your preferred pharmacy. Super easy.
Does Phexxi Have Side Effects Or Drawbacks?
One of the concerns with Phexxi is that it has to be timed an hour or less before sex, which can be hard to plan for. “It may be easily forgotten and compliance may be far from perfect,” Dr. Sekhon says. It is only 93% effective if timed correctly, so user error is a bit of a concern, though if you trust you'll remember to use it before sex, it could be a good option.
There are also some physical side effects of Phexxi to know about. “The most common side effects reported in clinical trials were vaginal burning and itching,” Dr. Sekhon says. “Less commonly, users might experience UTI. Male partners may also notice local discomfort (burning, itching), most of which are mild.”
There have been a few cases of urinary bladder infection and kidney infection reported in clinical studies. Dr. Chambers says to avoid Phexxi if you have had repeated urinary tract infections or other urinary tract problems. Of the women who used Phexxi in studies, 1.6% discontinued the clinical trials because of an adverse reaction, per the drug’s website.