What Doctors Want You To Know About Phexxi, a New, Non-Hormonal Birth Control Option

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In the 60 years since the FDA approved the first birth control pill—which uses hormones to stop ovulation and prevent pregnancy—it has become one of the most popular contraceptive options in the U.S. Data from the Centers for Disease Control and Prevention (CDC) show 65 percent of the 72 million Americans ages 15 to 49 are using some form of contraception; of that number, 13 percent of them specifically are using the birth control pill as their method of choice.

There are a wide variety of other hormonal contraceptive options on the market besides the Pill, including intrauterine devices (IUDs), birth control implants, vaginal rings, and the patch. These are all considered to be the most effective at preventing pregnancy. But not every person is into the idea of taking a medication that affects their hormones. Some people can experience side effects such as blood clots, altered mood, and weight gain. (Talk about a mood killer, right?)

Experts In This Article
  • Erica Cahill, MD, Dr. Erica Cahill is a clinical assistant professor of obstetrics and gynecology and complex family planning at Stanford University. Her research and teaching interests include expanding contraceptive options, examining the impact of legislation on reproductive health access, examining the social...
  • Heather Irobunda, MD, board-certified OB/GYN at NYC Health and Hospitals
  • Kelly Culwell, MD, OB/GYN and women’s health expert who has served as a medical officer for the World Health Organization

The non-hormonal birth control methods are a bit more limited; currently, we've got condoms, copper IUDs, diaphragms, and sponges on that front. But in September, those options will widen a bit further with Phexxi, the first non-hormonal birth control gel.

Intrigued? Keep reading for everything you need to know about Phexxi birth control.

How it works

As mentioned, Phexxi is a gel without hormones that aims to prevent pregnancy. "Phexxi is self-administered through an applicator, similar to a tampon," says Kelly Culwell, MD, the chief medical officer of Evofem Biosciences (the company that produces Phexxi). "You use it only when you need it, but it must be used either immediately before or anytime up to one hour before every act of vaginal intercourse," she says.

Typically, non-hormonal contraceptive methods work through a variety of methods; condoms and diaphragms physically prevent sperm from getting into the vagina or through the cervix, for example, while spermicide affects how well sperm swim (making it harder for them to fertilize an egg). Meanwhile, Phexxi affects the environment of your vagina to prevent pregnancy. "[It] works by maintaining a [person's] vaginal pH within 3.5 to 4.5, which is a naturally acidic environment that is inhospitable to sperm and other bacterial pathogens," Dr. Culwell explains. "When semen is introduced, the pH in the vagina [temporarily] increases, which allows sperm to remain mobile and make their way up the reproductive tract and fertilize the egg." But when a person uses Phexxi, she says, their vaginal pH is able to stay in its usual acidic state—which effectively "immobilizes" the sperm.

Dr. Culwell adds that there are other benefits to the treatment being a gel rather than the standard pill, patch, or other forms of birth control. "First, the gel is an on-demand method to be used when [people] are actually engaging in sex. No need to take a pill every day or have an implant," she says. "Second, because it is not absorbed into the bloodstream, it is less likely to cause systemic side effects that hormonal birth control options can trigger [in some people]."

The pros and cons, according to OB/GYNs

Well+Good reached out to three gynecologists unaffiliated with Phexxi to get their opinions on this novel birth control method; all three expressed excitement over having another option. "I'm seeing more and more women interested in avoiding hormones for contraception, making this an ideal choice for those who won’t or can’t take hormones," says Alyssa Dweck, MD, who was named by both New York magazine and Westchester magazine as a top gynecologist.

One of the pros of this option, the experts say, is that Phexxi can be used on an as-needed basis instead of every day. Erica Cahill, MD, a clinical assistant professor of obstetrics and gynecology and complex family planning at Stanford University, points out that because it's a non-hormonal method, it won't affect the menstrual cycle. "Some people prefer to avoid hormonal birth control as they do not want to experience some of the side effects, particularly for the birth control pill, which can include for some people changes in mood, bloating, and nausea," she adds.

However, there are some criticisms of Phexxi to be aware of, too. Heather Irobunda, MD, an obstetrician-gynecologist based in New York City, says changes in vaginal pH levels are exactly what causes yeast and other vaginal infections, which leads her to believe that using it could come with these unwanted side effects. "The studies of Phexxi showed that one out of five participants had a vulvovaginal burning sensation and 5.7 percent had urinary tract infections," Dr. Cahill adds. "The investigators say these symptoms improve over time, but any person who is already bothered by vaginal irritation or recurrent urinary tract infections may be better served by a different birth control method."

Dr. Cahill also points out that 13.7 percent of people in the Phexxi studies became pregnant, which is less effective than birth control pills. And of course it should be noted that it doesn't protect about sexually transmitted infections the way condoms do, although there is clinical studies taking place now to see it if could be used to effectively transmit against chlamydia and gonorrhea.

No birth control method is perfect for everyone and Phexxi is certainly no exception. The key is to of course talk to your doctor, who can help you figure out what option is best for you. If you do decide you're into Phexxi, you should be able to get it for free. "As part of the Affordable Care Act, contraception is a covered benefit under the preventative care section," Dr. Culwell says. "The ACA mandates that private health plans provide coverage with no out-of-pocket costs for at least one treatment per class in each of the categories identified by the FDA in its Birth Control Guide. We anticipate Phexxi will be one of those choices covered by a majority of insurance plans when this guide is updated due to the unique mechanism of action for Phexxi."

Dr. Irobunda says the release of a whole new type of birth control also reflects another positive change: Growing interest in scientific studies for birth control methods. "I think it is awesome that there is research being done to find more forms of birth control," she says. "The more options that are available, the better! We are all so different and respond to medications differently, so having more birth control options to offer to my patients is always welcomed."

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