March 14, 2022
By Olivia Hilal, MS4, Drexel University College of Medicine

If you have been watching a streaming service with ads in recent months, then there is a good chance an ad has popped up with Annie Murphy (Alexis Rose from Schitt’s Creek), promoting a new form of birth control approved on the market: Phexxi. Produced by Evofem Biosciences, Phexxi is a vaginal gel composed of lactic acid, citric acid, and potassium bitartrate. Approved last year, Phexxi is being marketed as a non-hormonal alternative to traditional hormonal oral contraceptives. It works by altering vaginal acidity directly before a sexual encounter to prevent sperm from being able to travel to and fertilize an egg¹.

In the media, there has been a perceived shift away from oral contraceptives. The movement seems to stem from the desire to have more options for birth control outside of hormonal options. While oral contraceptives have been used by millions of people worldwide for things like pregnancy prevention, cycle regulation or flow regulation, there can be side effects that outweigh the benefits. Common side effects of oral contraceptives include acne, mood changes and fluctuations in libido, and some of the menstruating public is looking for alternatives to decrease their chance of experiencing these side effects. Others worry about the potential psychological implications of oral contraceptives and the way that they affect those who have concomitant mood disorders².

The CEO of Evofem, Saundra Pelletier, spearheaded the development and commercialization of Phexxi. After working as a sales representative at G.D. Searle, the pharmaceutical company under which the pill was first developed, Ms. Pelletier felt there was a need in the market for non-hormonal options to be available for women. She had had breast cancer and was not able to take hormonal contraceptives due to the chance that it could worsen her disease. As a result, she created Phexxi to be used as needed prior to a sexual encounter.

When compared to other forms of birth control, Phexxi’s main difference is the non-hormonal nature of this vaginal gel. The side effect profile includes vaginal burning and itching, urinary tract infections, vaginal yeast infections and bacterial vaginosis. When compared to a common spermicide on the market, Conceptrol, the risk of these side effects is slightly less in Phexxi (e.g., 13.07% risk of UTI in Conceptrol as compared to 9.60% in Phexxi)³. As far as pregnancy prevention, Phexxi ranges around 89.5% with typical use, and 95.9% with perfect use. Overall, this is less effective than oral contraceptives (92%), IUD or progestin implants (<99%). Although not currently approved for sexually transmitted infection prevention, Phexxi is currently being studied for use as chlamydia and gonorrhea prophylaxis given the current rise in antibiotic resistant gonorrhea⁴.

Currently, Phexxi is encountering difficulties being covered by insurance. Since it is a relatively new form of birth control, it is not yet included on many regulatory websites, such as the FDA’s birth control chart. By most insurance companies, it is currently considered a spermicide, and under current guidelines only one type of spermicide is required to be covered. In order to increase coverage of Phexxi, it would need to be classified as a different method of contraception entirely. As it stands, Phexxi comes in a box of 12 single use applicators, totaling to $267.50 without insurance⁴.

With so many options for birth control on the market, and new products constantly being reviewed and studied, finding the right option for you can be difficult. Having all of the information available to you is important when it comes to making a decision that is best for you and your body. Having an open discussion with your doctor about the many forms of contraception and which might work best with your lifestyle is the first step in understanding the ever-changing medicines on the market. If you’d like to compare and contrast different forms of birth control, in addition to the information about Phexxi above, this link will take you to the FDA’s birth control chart: fda.gov/consumers/free-publications-women/birth-control-chart (Note that temperature regulating ovulation apps and Phexxi are not included on the FDA’s current chart).

Sources/Resources:

• “Hormone Free Birth Control: PHEXXI®.” Hormone Free Birth Control | Phexxi®, Evofem Biosciences, Sept. 2021, phexxi.com/.
• Klaus, H., & Cortés, M. E. (2015). Psychological, social, and spiritual effects of contraceptive steroid hormones. The Linacre quarterly, 82(3), 283–300. https://doi.org/10.1179/2050854915Y.0000000009.
• Steinberg J, Lynch SE. Lactic Acid, Citric Acid, and Potassium Bitartrate (Phexxi) Vaginal Gel for Contraception. Am Fam Physician. 2021 May 15;103(10):628-629. PMID: 33982994.
• Andrews, Michelle. “Contraception Is Free to Women, except When It's Not.” NPR, 21 July 2021, https://www.npr.org/sections/health-shots/2021/07/21/1018483557/contraception-is-free-to-women-except-when-its-not.