Doctor's Note: Phexxi Contraceptive Gel

Many people skip hormone-based birth control for a variety of reasons. Some have medical conditions that make taking hormones too dangerous, while others don't tolerate the side effects or have personal reasons.

Phexxi is a newer, nonhormonal contraceptive designed for people who want or need contraception without the hormones. It is marketed as an easy-to-use, hormone-free, as-needed contraceptive, meaning it is only used prior to sex rather than every day.

Sounds perfect for anyone hoping to avoid hormones, but how effective is it and how does it work?

What is Phexxi?

Phexxi is a birth control gel inserted into the vagina up to one hour before sex. The gel keeps the vaginal pH at its normal low level in the presence of sperm, so it's more difficult for the sperm to move through the vagina and into the uterus to reach the egg.

Without Phexxi on board, semen naturally raises the vaginal pH to allow it to move.

"Once inserted into the vagina, Phexxi maintains a normal vaginal pH and works to keep vaginal pH in the 3.5 to 4.5 range, which lowers sperm mobility. When sperm can't swim, it lowers the chance of them reaching the egg," the Phexxi website states.

The key words are "lowers the chance." It is distinctive from spermicide in that Phexxi does not kill sperm. It simply makes their job a lot harder.

How effective is Phexxi?

The manufacturer states that with typical use, Phexxi is 86 percent effective. Put another way, that is 14 unintended pregnancies per 100 sexually active people per year. "Typical use" means the way the majority of the population uses Phexxi, as compared with "perfect use" or the way the package insert states.

A few factors can affect how well Phexxi works. These include:

• Contraceptive storage
• Expiration date
• Product use

The manufacturer also states that in a separate analysis, because Phexxi is used "as needed," it prevents pregnancy 99 percent of the time. It further states that this separate analysis was not subjected to the same level of scrutiny as the data in the product information.

Let's compare the effectiveness of other forms of contraception on the market. A chart presented by the American College of Obstetricians and Gynecologists (ACOG) also includes "typical use" efficacy rates.

Based on this chart, it's easy to see that Phexxi falls within the less effective forms of contraception available. However, it certainly has a role and is far more effective than the pull-out method or fertility awareness method. For some women, Phexxi is an attractive option, but it is just as important to know the limitations of this product.

Herein lies the concern with Phexxi. It simply "lowers the chance" of pregnancy. This is perfectly acceptable to certain people and potentially catastrophic for others. If someone is open to an unintended pregnancy and wants to avoid hormones, then Phexxi could be a good fit.

If someone absolutely does not want to become pregnant or has a medical reason they should not become pregnant, then Phexxi is not something I would advise as a standalone contraceptive.

The bottom line

Phexxi may be a sound choice for people who cannot use certain forms of birth control. Pairing it with condoms or a diaphragm could increase efficacy (not to mention that condoms protect against sexually transmitted infections), but there are no studies to tell us the effectiveness of these combinations. Phexxi should not be used with a vaginal ring.

If you have questions about this product or any other contraceptive, please reach out to an OB-GYN or similar gynecological provider so they can help you make the best choice based on your personal medical history and goals.

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