Nonhormonal birth control can be an effective way to prevent a pregnancy for people who have certain health conditions or want to avoid the side effects of hormonal contraception.
The options for nonhormonal birth control consisted of barrier methods (such as condoms and cervical caps), spermicides, copper intrauterine devices (IUDs), and sterilization, among others, until recently, when a new option called Phexxi became available.
The Food & Drug Administration (FDA) approved the vaginal gel on May 22, 2020, expanding the variety of nonhormonal birth control people can choose from.
“Prior to the approval of Phexxi, there hadn’t been major innovation in nonhormonal birth control in over 30 years,” said Dr. Charis Chambers, OB-GYN.
Keep reading to learn more about the new nonhormonal birth control gel, including:
- potential side effects
- how well it works
- where to find it
- how to decide if it’s right for you
Phexxi is a new nonhormonal birth control gel, available by prescription, that is placed inside the vagina just before penis-in-vagina sex to reduce the risk of pregnancy. It works by preventing semen from changing the pH of the vagina.
A vagina is usually acidic, with a pH of around 4, according to the National Women’s Health Network (NWHN). When semen enters the vagina, the pH typically climbs to a neutral or mildly basic level of 7 or 8, which creates a more protective environment for sperm.
The gel keeps the pH of the vagina in the more acidic range, making it inhospitable to sperm.
In other words, “it paralyzes the sperm so it cannot survive and get someone pregnant,” explained Dr. Tamika Cross, board certified OB-GYN.
What is it made of?
Phexxi is made of three active ingredients:
- lactic acid, which is found in dairy products and produced naturally by the vagina
- citric acid, a compound found in citrus fruits
- potassium bitartrate, a byproduct from winemaking that’s also known as cream of tartar (a baking ingredient)
These three ingredients work together to maintain the acidic pH of your vagina amid the presence of semen.
Who should use it?
The birth control gel can be used by many people with vaginas who want to prevent pregnancy without using hormones.
“Phexxi is good for patients who can’t use hormonal birth control because of some type of medical condition — whether that’s a history of cancer or blood clots,” said Cross.
It can be a good choice if you’re looking for a nonhormonal birth control option that:
- doesn’t have to be taken every day
- is easy to start and stop using
- won’t affect your long-term fertility
- can be used discreetly without your partner’s participation
- can be used in the moment and at any time during your menstrual cycle
- is safe to use multiple times per day
- can be used with some (but not all) other types of birth control
You can use the birth control gel as soon as your doctor clears you for penis-in-vagina sex after childbirth, miscarriage, or an abortion, according to the NWHN.
However, Planned Parenthood notes that there are some reasons you may want to avoid Phexxi, including:
- you use the vaginal ring
- you’re pregnant (or think you might be)
- you have a history of urinary tract infections (UTIs) or other urinary problems
- you (or your partner) are sensitive or allergic to the gel’s active ingredients
It’s also important to note that Phexxi does not prevent sexually transmitted infections (STIs). You may need to combine it with another type of birth control, such as a barrier method, to reduce your risk for STIs.
Phexxi is used in a similar way to some spermicides, in that you place it in the vagina before penis-in-vagina sex.
The gel comes in prefilled, individually wrapped applicators. To use it, you’ll need to unwrap the packaging, push the plunger rod into the applicator, and remove the pink cap.
Then you slide the applicator into the vagina as far as is comfortable while holding onto the grooved area. Finally, use your index finger to press the rod, which will insert the gel into the vagina, and remove the applicator.
For Phexxi to be most effective, it should be used no more than 1 hour before penis-in-vagina sex. You will also need to use another applicator of gel if you plan to have another round.
“One Phexxi dispenser is equivalent to one ejaculate,” said Cross.
When used as directed by a medical professional, Phexxi is 93 percent effective, according to the company. But in typical use (meaning it may not be perfect), its effectiveness drops to 86 percent.
That means it may not work for roughly 14 out of every 100 people who use Phexxi as their sole method of birth control.
Nonhormonal birth control gel has a higher effectiveness than that of a male condom, female condom, or spermicide, per the
Using Phexxi with some other types of birth control can make the gel more effective, though. While it can’t be used with vaginal rings, it can be used with:
- cervical caps
- birth control pills
- the birth control patch
You will need to use another type of birth control to prevent STIs.
While Phexxi doesn’t come with the same side effects as hormonal birth control, it does have certain risks.
The most common side effects of the nonhormonal birth control gel include:
- vaginal burning, itching, or discomfort
- yeast infections
- bacterial vaginosis (a type of vaginal inflammation from bacteria)
- vaginal discharge
In clinical studies of the gel, a few cases of bladder and kidney infections were reported, one of which was serious.
With that said, side effects are uncommon, and when they do happen, they tend to be mild. Fewer than 2 percent of participants in clinical trials stopped using Phexxi due to an adverse reaction, according to the manufacturer.
Unlike some other types of birth control, Phexxi may cause side effects for your sexual partner, as well. Some men have experienced genital discomfort after having penis-in-vagina sex with someone who used the gel.
You should not use Phexxi if you or your partner are allergic to the birth control’s ingredients, which include:
- lactic acid
- citric acid
- potassium bitartrate
Phexxi is sold in boxes of 12 prefilled applicators for a total of $267.50, but the actual price you pay at the pharmacy may be substantially less, depending on your circumstances.
If your health insurance plan covers the birth control gel, you may be able to get it for less, or even pay nothing at all. Those without insurance may be able to get it for free or at a low cost through their local Planned Parenthood health center.
Phexxi also offers a savings program that offers a $0 copay for a person’s first box and prices as low as $30 for refills. However, only certain people are eligible to participate. The program is not available to people who use certain government programs, like Medicare and Medicaid, to cover some or all of their prescription medications.
While Phexxi is the newest nonhormonal birth control option approved by the FDA, other options are also in the works.
There is a new copper IUD — the IUB Ballerine — which was
While the IUB Ballerine is used in 30 countries, it is not yet approved in the United States.
Meanwhile, another startup company, Cirqle Biomedical, is working on a new type of nonhormonal birth control called Oui. It’s a capsule designed to quickly dissolve inside the vagina to make the cervical mucus impenetrable to sperm.
While the product has shown positive results in animal trials, it still needs to demonstrate safety and effectiveness in human clinical studies before it becomes available, per Forbes.
Talk with your doctor to learn more about new types of birth control available to you.
The FDA approved a new birth control gel called Phexxi in May 2020, expanding the available options of nonhormonal contraception.
It works by lowering the pH in the vagina to make it difficult for sperm to penetrate an egg. You can insert the gel into the vagina using a prefilled applicator up to an hour before penis-in-vagina sex.
Side effects are relatively uncommon, but if you have a history of UTIs or bladder problems, you may want to try another birth control method.
Talk with your doctor about the risks and benefits of Phexxi to see if a prescription for the birth control gel is right for you.