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 regard to birth control and family planning.
Phexxi is a topical birth control gel that’s approved by the FDA to prevent pregnancy. Phexxi's website calls the treatment "A Hormone-Free Revolution in Birth Control."
But is Phexxi really as effective as other FDA-approved birth control methods like the pill or IUD? Does it have side effects? How does it even work? And does it contain any questionable additive ingredients?
In this article we’ll answer all of these questions and more as we review clinical studies on Phexxi to determine how effective it is, how it compares to other birth control methods like the pill and IUD in terms of pregnancy reduction, what the side effects of the gel are and whether it contains any questionable additive ingredients.
Does Phexxi Work?
The effectiveness of Phexxi has been examined in various research studies. A clinical trial published in the Contraception: X journal 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 above-linked study, so using Phexxi definitely decreases that rate. However, an unintended pregnancy rate of over 10% is still quite high in our opinion.
A more recent clinical trial found similar results: data from 1,330 women was evaluated and 13.7% of these women became pregnant within six months of use.
Phexxi is effective for reducing unintended pregnancy, but is significantly less effective than other FDA-approved birth control methods, as we'll document in the next section.
Phexxi vs. Other Birth Control Methods
Phexxi appears to be less effective than other popular forms of birth control, but only somewhat less effective than "the pill," which refers to an oral, hormonal contraceptive.
As we documented in our review of the Vienva birth control pill, the failure rate of the pill with "typical use" is around 8%. Typical use includes human error such as occasionally forgetting to take the pill.
The efficacy of the male condom was found to be 87% with typical use and 98% with perfect use. “Perfect use” refers to use as directed on the product label every single time during sex.
A medical review published in the Open Access Journal of Contraception documented intrauterine device (IUD) failure rates to be under 1% per year.
Phexxi has a similar rate of effectiveness to the male condom, but we would consider it to be somewhat less effective than the pill and significantly less effective than IUD based on a review of clinical research.
A popular YouTube creator named Mama Doctor Jones who's a board-certified OBGYN compared the effectiveness of Phexxi with other birth control methods to determine which is the safest:
How Does Phexxi Work?
Phexxi is a gel that’s applied inside of the vagina using a four 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, 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 worth noting that condom use in addition to Phexxi would significantly reduce the risk of unintended pregnancy compared to Phexxi use alone. Phexxi in this case would provide a fallback contraceptive option even if the condom broke or failed.
A video published on the official Phexxi YouTube channel explains how the drug works and includes animated videos showing how the device is used:
Does Phexxi Cause Side Effects?
Phexxi is relatively free of significant side effects, which is unsurprising since it’s just a topical gel and not an oral treatment that's absorbed into the bloodstream.
One of the medical reviews cited in the research section documented the side effect rate of Phexxi: burning sensation (18% of participants experienced this side effect), itching (14.5%), vaginal infection (9.1%), UTI (9%), bacterial vaginosis (8.1%) and vaginal discharge (5.5%).
This side effect profile does not document any life-threatening or severe side effects, but the rates of side effects like infection seem relatively high in our opinion.
How Much Does Phexxi Cost?
Phexxi is a prescription medication, which means the cost will vary for U.S. patients based on their insurance coverage.
GoodRx reports that the retail price of Phexxi is $267.50 for 12 applicators (good for 12 sessions of intercourse) at the time of updating this article, which is a relatively high price, especially compared with the cost of male condoms.
The Prescriptions and Savings page on Phexxi's website has a hotline that prospective patients can call to inquire if they're eligible for co-pay savings. The website states that women eligible to enroll in the Phexxi Savings Program may be able to receive their first shipment of Phexxi free.
Does Phexxi Have Questionable Additive 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: 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. For some topical formulations to be safe and stable, preservatives are necessary, but we typically recommend avoiding topical products containing preservatives unless otherwise recommended by a doctor.
Benzoic acid is one of the least harsh preservatives.