Meet Phexxi—a hormone-free, user-controlled prescription birth control gel

Used only when needed, Phexxi changes the vaginal pH in the presence of semen to prevent pregnancy.

by Robin Watkins, CNM, WHNP-BC

published 03/15/21

The FDA approval of Phexxi means a new hormone-free, user-controlled prescription birth control option for patients. Phexxi gel (lactic acid, citric acid, and potassium bitartrate) prevents pregnancy by maintaining the vaginal pH within its naturally acidic range, keeping it inhospitable to sperm and reducing sperm mobility. In clinical trials, Phexxi was 93% effective in preventing pregnancy with perfect use and 86% effective with typical use.

The basics of using Phexxi

  • Each box of Phexxi comes with 12 one-time use, pre-filled applicators.
  • Patients self-administer, similar to placing a tampon, up to one hour before having penis-in-vagina sex.
  • A new dose is needed for every additional time someone has penis-in-vagina sex—even if it’s within one hour.
  • Phexxi does NOT prevent pregnancy when administered after intercourse.

Risks and contraindications

Phexxi is hormone free and can be safely used by almost anyone who is at risk for pregnancy. Phexxi can cause vaginal itching and burning in some users and some partners reported genital discomfort as well. However, less than 2% of users in clinical trials stopped using it due to an adverse reaction. Patients with more than three urinary tract infections in the previous year or other urinary tract problems were not included in the clinical trial of Phexxi. For patients who fit these criteria, counseling on Phexxi should consider the lack of data in this population.

Phexxi does not protect against any sexually transmitted diseases, including HIV.

People who use the vaginal ring for birth control should not use Phexxi, but it can be used at the same time as any other birth control method.

How to get Phexxi

You can prescribe Phexxi for your patients or they can get it delivered to their door after a telehealth visit through Phexxi’s platform

The cost of Phexxi depends on if patients have health insurance. With insurance, the cost of Phexxi may be covered. For patients with a copay, Phexxi offers a copay savings plan where they may pay as little as $30 for each box of 12 one-time use, pre-filled applicators of Phexxi. Without insurance or for patients on a plan that doesn’t cover birth control, Phexxi can cost an average of $280 out of pocket per box.

Bottom Line

Phexxi is a novel birth control gel, that is a good option for anyone who wants a hormone-free, patient-controlled method that only needs to be used when needed.

Robin Watkins is the Director of Clinical Affairs and Medical Education at the Society of Family Planning. Robin is a midwife and women’s health nurse practitioner focused on expanding provider capacity to offer just, equitable, resonant, and high-quality sexual and reproductive health care. Robin provides clinical care in the Washington, DC area. When she is not talking sex or placing IUDs, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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