Phexxi: What to Know About the Non-Hormonal Birth Control

Lately, a friend of mine has been talking about Phexxi—a newish non-hormonal birth control gel she was thinking of trying. I don't love admitting this, but I had somehow missed the news on this product and had no idea what she was referring to.

Given that this non-hormonal birth control gel has been growing in popularity, there's a pretty good chance you might have heard of it too. To help you out, our team at Byrdie decided it's time to reach out to some experts in the field of gynecology to learn the ins and outs of this new birth control gel.

Here's what you need to know about Phexxi birth control gel.

What Is Phexxi?

Phexxi is a hormone-free contraceptive gel that came on the market in May 2020. It's different from some other forms of birth control in that it doesn't contain hormones and it's designed to be used as needed, before sex. So there's no onetime semi-permanent insertion like with an IUD, or having to remember to take a daily pill, as required with hormonal birth control pills.

Phexxi's contraceptive gel is FDA-approved and available by prescription only. As with most prescription medication in the United States, the actual cost you pay will depend on your health insurance. Experts point out that Phexxi can be a bit pricey, roughly $300 for 12 uses.

How Does Phexxi Work?

Phexxi is a gel that is inserted into the vagina (with the help of an applicator—more on that in a bit) within an hour before having sex. It works immediately, so once inserted, you're ready to go.

At this point you might be wondering, How will this contraceptive gel actually work in my body to prevent pregnancy? Tamika Cross, MD, explains that the product uses non-hormonal ingredients like lactic acid, citric acid, and potassium bitartrate to create an environment that immobilizes sperm.

Okay, but how exactly does the gel keep that sperm from swimming? Basically, Phexxi does this by helping your body maintain its vaginal pH. Typically, when sperm enters the vagina, the vaginal pH increases. But Phexxi helps maintain a more normal, or acidic, vaginal pH. At this lower pH, the sperm isn't able to make its way to the egg, where fertilization can occur.

"I think of it like a spermicide," Sophia Yen, MD, says, "but it doesn’t technically kill the sperm. Instead it reduces sperm motility."

How Do I Actually Use Phexxi?

Here's how Phexxi works, according to its website.

1. First, you prep the applicator (it's a bit like a tampon applicator).
2. Next, insert the applicator into your vagina, and then press the end of the applicator to release the gel.
3. Remove the applicator from your vagina.

Note, Phexxi is only effective if it's used immediately prior to intercourse. Also, remember you need to use a new applicator each time you have sex. "This needs to be done every time the person with a penis might ejaculate," Yen explains. "So if you have sex three times in one night, you will need three applicators in one night."

At around $300 for 12 uses, we can see how the costs could ramp up pretty quickly for this product.

Why Non-Hormonal Birth Control?

While hormonal birth control pills are generally safe, they do carry side effects such as migraines, bloating, weight fluctuations, and weight gain. They can also increase your risk of health conditions like blood clots and high blood pressure. If you're a current smoker and are over the age of 35 or have hypertension may be advised not to take combination birth control pills or other forms of hormonal birth control, according to Dr. Amber Klimczak, MD, fertility doctor based in Basking Ridge, New Jersey. In some of these cases, birth control like Phexxi can be a good option.

Is It Safe?

Phexxi is safe, but it carries some potential side effects. These may include vaginal burning, itching, discharge, pain, yeast infections, genital discomfort, urinary tract infections, bacterial vaginosis, and painful urination.

You shouldn't use Phexxi if you have a history of recurrent urinary tract infections or urinary tract abnormalities, or an allergy to any of the product's ingredients.

Additionally, you'll want to be sure not to use Phexxi if you're also using a vaginal ring. This is because Phexxi can lower the vaginal ring's efficacy as a contraceptive, our experts say.

How Does Phexxi Compare With Other Forms of Birth Control?

Phexxi is an effective form of birth control, but it's not as effective as some other types of contraception. "When used properly, it is not as effective as an IUD or implant. However, it can be more effective than condom use alone," Cross says.

The company says Phexxi is 93% effective when used as directed and 86% effective with typical use (which includes times when directions aren't followed to a T). This means that with perfect use, 7% of women using it will get pregnant, and without perfect use, 14% of people using it will get pregnant, Yen says. For this reason, she does not recommend using it alone and instead suggests using it in combination with another form of birth control, such as a condom. As we mentioned earlier, be sure not to use Phexxi in combination with a vaginal ring.

"The greatest disadvantage of any non-hormonal birth control methods is a higher risk of pregnancy," Yen says. "Why take a 14% risk when the pill, patch, or ring have only a 7% risk of failure?"

The Final Takeaway

Phexxi has its advantages in that it can be used on-demand and is free of hormones. But it can also be expensive, and it hasn't been proven to be as effective as some other forms of birth control, like IUD, implant, or a combined hormonal contraceptive pill.

Contraception is important, and it can be tricky to figure out what type to use. Your best bet is to speak to a healthcare professional to see whether Phexxi is a good option for you.