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Fact Checked

FDA Approves New Birth Control Gel – Is It Right for You?

Phexxi (lactic acid, citric acid and potassium bitartrate) is a new drug approved for use in women to prevent pregnancy and possibly increase sexual satisfaction. Women can apply the non-hormonal contraceptive gel vaginally just before having intercourse. It works by maintaining an acidic pH in the vagina, causing an unfriendly environment for sperm that are present. The company behind Phexxi also emphasizes that the product empowers women by providing them greater control over pregnancy prevention. So, where does it fit in the spectrum of available birth control options?

Understanding Vaginal pH 

The concept of pH is used when discussing the acidity of a water-based solution. The pH scale ranges from 1 to 14, with 1 being the most acidic and 14 the least. The vagina usually has an acidic pH of less than 5. This slightly acidic environment allows for the growth of healthy, good bacteria. Disrupting this environment by changing the pH level for extended periods can allow less favorable organisms to grow, leading to yeast infections and other issues. 

Semen is alkaline, the opposite of acidic. As a result, during unprotected intercourse, pH is temporarily higher (less acidic) in the vagina, reaching levels as high as 7 or 8.

Using Phexxi for Birth Control

Based on the AMPOWER drug trial, Phexxi has an 86% effectiveness rate at preventing pregnancy, but the company claims that with the perfect technique, it can be as high as 93%.

It comes in a pre-filled, single-use applicator that can be inserted into the vagina either immediately before intercourse or an hour earlier and must be reapplied for each act of intercourse. Applying Phexxi after the fact will not be effective. It is compatible with some other forms of birth control, including most condoms and hormonal contraception.         

Place in Therapy

In the United States, around 45% of all pregnancies are unintended. Birth control methods range from short term and reversible to permanent, and the efficacies and ease of use of the different methods vary as well. How do they compare?

Table 1: Comparison of Effectiveness of Various Birth-Control Methods

Method

Actual Effectiveness

Condoms

85

Diaphragm

88

Spermicides

71

Intrauterine Device (IUD)

99

Sterilization (Male)

99

Sterilization (Female)

99

Hormonal Contraceptives

91

Vaginal Ring

91

Depot Shot

94

Barriers and Spermicides

The easiest and most reversible forms of birth control are barrier contraceptives and spermicides. However, their effectiveness relies on proper technique and use. For example, condom use is 98% effective at preventing pregnancy, but taking into account “user error,” the number is closer to 85%. Spermicides are even less effective. 

Hormonal Options

One of the best-known birth control methods is “the pill,” which contain hormones. It requires taking a tablet each day without missing a day (or perfect adherence) to prevent ovulation (or the release of an egg).

There is also an increased risk of cardiovascular events (e.g., heart attack or stroke) with most hormonal birth controls (especially if you are a smoker). Also, the pill does not protect against sexually transmitted infections (STIs).

Intrauterine Devices (IUDs)

IUDs are a highly effective long-term option for birth control. They require an office visit for insertion and can last five to ten years (depending on the IUD). Like the pill, IUDs do not protect against STIs.

Injectable

Medroxyprogesterone is available as a shot for birth control that lasts up to 3 months. It is usually administered by your healthcare provider in the office, and side effects may include nausea, weight gain, and headaches.

The Ring

Products like NuvaRing are designed to be inserted by the user and remain in place for 3 weeks. The ring does not have to be removed for intercourse. If it is, the ring is still safe to use if reinserted within 3 hours. Some women do experience vaginal discharge or itching with use.

The Permanent Option

Sterilization is another option, and although it can often be reversed, it should be considered a permanent choice. It is the most effective method for birth control.

Where Does Phexxi Come In?

With all these options in mind, Phexxi appears to be a good non-hormonal second-option form of birth control. It is less effective than many methods, but it is portable and specifically designed to empower women by providing them with greater control. 

The Positives:

  • No barrier between participants
  • May provide more lubrication
  • Can be used just before intercourse
  • Portable, pre-filled applicator
  • Controlled by the woman

The Drawbacks:

  • Decently effective, but not as effective as some other methods
  • Burning, itching, and bacterial infection are possible side effects
  • Some male partners complain of similar burning or itching
  • Phexxi might be costly at a cash price of $270 for a 12-pack

Weighing Pros and Cons

The most effective form of birth control is the one that gets used and with the best technique. Partners should make an informed decision ahead of time and agree on what kind of method they will use before intercourse takes place. 

According to the manufacturer, Phexxi is safe for use alongside other birth control methods, including hormonal contraception and most types of condoms. It comes in a pre-filled, ready to use applicator and can be used in the absence of a barrier form of birth control. According to the AMPOWER drug study, Phexxi may also improve a woman’s sex life compared to other forms of birth control.

However, the side effect profile may deter some women from using it. Additionally, a male partner may also prefer another method if he experiences burning or itching because of using Phexxi. However, the manufacturer does say that burning and itching decrease with each consecutive cycle.

Ultimately, which birth control method is right for you depends on your individual health circumstances and preferences. For more information, speak with your doctor or pharmacist to learn more.  

References:

Published June 22nd, 2020 by Dr. Brady McNulty, PharmD, BCGP
Fact Checked by Chris

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