Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regards to prescription medication.
Phexxi is a topical birth control product that’s approved by the Food and Drug Administration (FDA) to prevent pregnancy. It’s a more convenient birth control method than an Intrauterine Device (IUD) or pill, but is it as effective?
In this article we’ll review the medical research on Phexxi to determine whether it’s safe and effective, and compare its relative efficacy to other birth control methods.
Does Phexxi Work?
Phexxi does reduce the risk of unintended pregnancy. If it didn’t, it wouldn’t have been approved by the FDA. One of their clinical trials tracked 1,114 women over 145 days on the treatment, and the rate of unintended pregnancy was reduced to 12.5%.
The average rate of unintended pregnancy is close to 50% without any contraceptives as reported in the linked study, so using Phexxi definitely decreases that rate. However, an unintended pregnancy rate of over 10% is still quite high in our opinion.
We cannot locate any other clinical trials on the efficacy of Phexxi, so we believe the above-linked trial was the main trial that led to FDA approval. Many of the other prescription medications we’ve reviewed had many clinical trials prior to approval, so we find the data backing Phexxi to be relatively weak.
How Does Phexxi Work?
Phexxi is a gel that’s applied inside of the vagina using a 4 inch pre-filled applicator device. The gel decreases the pH of the vagina, due to its active ingredients of citric acid, lactic acid and potassium bitartrate.
As detailed in this 2022 medical review of contraceptives published in the Family Planning journal, Phexxi helps to maintain the naturally acidic environment of the vagina in response to sperm, which is alkaline. This reduces sperm motility which can reduce unintended pregnancy.
It’s not detailed in either of the medical studies we’ve reviewed, but we would guess that many of the Phexxi trial participants were having unprotected sex, since it’s rare for patients to use multiple methods of contraception simultaneously.
It’s worth noting that condom use in addition to Phexxi would significantly reduce the risk of unintended pregnancy compared to Phexxi alone. Phexxi in this case would provide a fallback contraceptive option even if the condom broke or failed.
Phexxi Side Effects
Phexxi is relatively free of significant side effects, which is unsurprising since it’s just a topical gel and not a systemic treatment. However, Phexxi participants in the clinical trial did report a somewhat high number of side effects overall.
45% of women taking part in the Phexxi trial reported at least one side effect, with the most common being vaginal burning (20%) or itching (11%). Pain was reported in 4% of patients, and 2% of patients had significant enough side effects that they chose to discontinue the trial.
This side effect profile is less severe than other forms of birth control such as hormonal birth control (“the pill”) and IUD birth control.
Phexxi Vs. Other Birth Control Methods
Phexxi appears to be less effective than other popular forms of birth control based on a review of medical research, but only somewhat less effective than the pill.
As we detailed at length in our review of copper IUD device Paragard, the failure rate for the birth control pill ranges from 7-9% with typical use.
The efficacy of the male condom was found to be 87% with typical use and 98% with perfect use.
In the context of medical trials, “typical use” means use over long periods of time and includes incorrect or inconsistent use. So for example, a couple having regular sex using a male condom as their method of contraception over the course of a year may forget to use the condom at all one or two times. This would still be included in the “typical use” category, which is why the efficacy rates can vary so much.
“Perfect use” refers to use as directed on the product label every single time during sex.
The rate of effectiveness for the IUD ranges from 94% to 100% as discussed in our Paragard review, making it the most effective birth control method.
Phexxi has a similar rate of efficacy for birth control when both methods are used in a “typical” fashion, but male condom is more effective than Phexxi when used in a “perfect” manner.
The IUD is significantly more effective than Phexxi.
Phexxi is a prescription medication, which means the cost will vary for U.S. patients based on their insurance coverage. Phexxi offers the option for consumers to get a prescription online, which is convenient and can save them money compared to having to schedule a visit to their doctor to inquire about Phexxi.
We still recommend that patients speak with their doctor before ordering Phexxi, because your doctor will be able to make a recommendation based on your individual needs and current medications.
Phexxi’s website suggests that some patients with commercial insurance may qualify for a $0 rate if their insurance subsidizes the entire cost of treatment.
GoodRx reports that the cost of Phexxi without insurance is nearly $300 for only 12 applicators (good for 12 sessions of intercourse), which is a relatively high price, especially compared with the cost of male condoms.
Phexxi Inactive Ingredients
We already reviewed the active ingredients in Phexxi that contribute to its effectiveness, but the treatment also contains several inactive ingredients according to its FDA label information: glycerin, alginic acid, xanthan gum, sodium hydroxide, benzoic acid, purified water.
We find the inclusion of benzoic acid to be notable as this is a preservative. While it’s been shown in a medical study to have antifungal effect, we wonder whether the topical application of these additive ingredients to the sensitive vaginal environment may contribute to some of the uncomfortable side effects such as itching or burning.