Phexxi Reviewed

Looking to prevent pregnancy? There are many options available.

Birth control pills, implants, and rings contain hormones that either prevent the release of an egg or change the cervical mucus so it’s harder for sperm to reach the egg.

If you’d prefer a nonhormonal birth control method that’s more on-demand, you might look into a product like Phexxi. This vaginal gel is used before intercourse, can be discontinued at any time, and is available with a prescription.

Here’s what you need to know including how to obtain it and how much does it cost.

What is Phexxi?

Phexxi is a gel you insert into the vagina before having vaginal intercourse. It prevents pregnancy by keeping the vaginal environment acidic, making it hard for sperm to swim up into the vagina and reach the egg.

You might be thinking… isn’t that what spermicides do? And you’re sort of right, but Phexxi works differently. Spermicides kill sperm, while Phexxi just makes it hard for them to swim.

How does it work?

Vaginal pH is generally around 3.5 to 4.5, which is considered (acidic). When semen enters the vagina, it raises this level to between 6.5 and 7.2, which makes it easier for sperm to move around since the environment is less acidic, or alkaline.

Phexxi works by maintaining the lower pH of your vagina. Keeping it lowered immobilizes sperm. When sperm cannot move, they can’t swim up to meet and fertilize the egg in the fallopian tubes.

Whereas spermicides use a chemical called nonoxynol-9 to kill sperm, the active ingredients in Phexxi are nontoxic and include lactic acid, citric acid, and potassium bitartrate.

Is Phexxi effective?

Phexxi is around 86 percent effective at preventing pregnancy with typical use. With perfect use, the gel can be up to 93 percent effective. More data from a 2021 study involving 1,330 women who used Phexxi, revealed that 13.7 percent became pregnant after 6 months.

Keep in mind that you may also combine the gel with a backup method, like condoms, to increase its effectiveness.

How to use Phexxi

You use Phexxi immediately before or up to an hour before you plan to have vaginal intercourse. First, wash your hands. Then, take one of the prefilled applicators and insert the gel into your vagina, much like how you would insert a tampon.

The consistency of the gel is such that it will not leak out during intercourse. Instead, it will come out of your body after sex mixed with your natural vaginal fluid and semen.

Important note: If you plan to have repeated vaginal intercourse, you will need to use another application of the product for full protection.

Does Phexxi have side effects?

Increased bladder or kidney infections are a possibility after using Phexxi. If you have frequent urinary tract infections (UTIs) or other urinary tract issues, you should speak with your doctor about whether this option is right for you.

Other side effects for women include things like itching, burning, yeast infections, or discomfort in and around the vagina. Unusual discharge and bacterial vaginosis are other possibilities along with pain with or without urinating. That said, only 1.6 percent of clinical trial participants left the study for these types of reactions.

Some men may experience symptoms, too. They include genital burning, itching, or pain.

Pricing and insurance

Without insurance, Phexxi may cost as much as $267.50. This price includes 12 applications of the product. Your health insurance carrier may or may not cover the full or partial price (depending on your copay). Since Phexxi is relatively new, it’s worth calling your insurer to ask before you go to get a prescription, which can prevent being surprised by the price.

You may also be able to obtain a copay card on the Phexxi website that provides the product at no cost to people who are eligible for the product’s savings program.

Where can I buy Phexxi?

You can purchase Phexxi directly on the website.

Remember: You need a prescription to get the product. The Phexxi website conveniently provides a link to make a telehealth appointment. You will have to pay any associated costs with the appointment, however.

Otherwise, you will need to make a doctor’s appointment with your own healthcare professional to get a prescription. Then you can buy Phexxi at your local pharmacy or another approved location where you buy your prescription medications.

What do OB/GYNs think?

Dr. Renee Mestad, assistant professor of obstetrics and gynecology at SUNY Upstate Medical University in Syracuse, NY, explains that Phexxi “doesn’t become runny when it experiences body heat…so it will stay in place [during sex].”

She adds that “the vagina likes to have an acidic environment…it won’t affect the balance within the vagina itself.” For example, conditions like bacterial vaginosis tend to flourish in higher pH environments, so a gel product like Phexxi (that keeps pH low) is unlikely to contribute to those kinds of issues for most people.

Mestad concludes that “[Phexxi] provides women their own autonomy”. It allows them to use it when they need it — when they want to prevent pregnancy and when they would like to stop — without needing a doctor’s appointment to remove devices or stop medications.

Pros and cons

As with any birth control method, there are pros and cons to using Phexxi. Discuss these points with your healthcare professional as you determine which method is best for you.

Pros:

• Protection is on demand — doesn’t need to be taken each day or all month.
• Does not contain hormones.
• Short term, so it will not impact fertility whenever you choose to stop use.
• Side effects, if any, are generally mild.

Cons:

• It requires a prescription.
• Not as effective as some other birth control methods.
• May lead to UTIs in some people.
• Does not protect against STIs.
• Can be costly without insurance.

How does Phexxi compare to alternatives?

Mestad explains that birth control pills are between “92 and 98 percent effective depending on how well you remember to take it.” Condoms — when used alone — are about 85 percent effective. And an IUD, implant, or sterilization, on the other hand, is more like 98 to 99 percent effective.

This puts Phexxi (86 to 93 percent effective) in the mix of solid birth control options, but it is not the most effective means when used alone. Its effectiveness can be improved when combined with other methods, like condoms.

The bottom line

Phexxi may work if you are looking for nonhormonal birth control to use as needed and if you want the option to get pregnant in the near future.

Make an appointment with your healthcare professional to discuss Phexxi and other birth control methods. Your doctor can help you determine which options are best for you and have a more in-depth discussion about the pros and cons as they relate to your health and lifestyle.

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