What's the scoop with Phexxi?

Question:

I am a Nurse Practitioner at Student Health. One of our physicians sent an article about Phexxi, a contraceptive option to use in conjunction with condoms if a patient did not want to use any standard birth control options. What are your thoughts about this?

Answer:

Phexxi is a relatively new product, approved in 2020, so your question is a great opportunity to examine its potential use in your population.

Although the mechanism of action is to inhibit sperm motility by acidifying the vagina so the sperm cannot ascend the reproductive tract, the manufacturer calls this a “pH vaginal modulator” rather than a spermicide. But the way it is used is like spermicides.

Some of the main advantages are—ease of use and that it is controlled by the user, and not dependent on a partner using condoms. One of the main disadvantages is—a high failure rate – more on that below.

Phexxi:

• Requires a prescription.

• Is a gel inserted vaginally as a prefilled single-dose application up to one hour before each act of intercourse

◦ Repeat with each act of intercourse

• Is non-hormonal

• Can be used with condoms, and cannot be used in combination with a vaginal ring

• Should not be used if someone has a history of recurrent UTIs or urinary tract abnormalities

Efficacy: results come from a 7-month trial (shorter contraceptive trial than usual)

The typical use pregnancy rate (over 7 months) is 11%, and the perfect use rate is 7%, but the estimated pearl index representing the first year of use is 27.5%. Stated in another way – almost 30% of women may get pregnant in the first year of use.

Incidence of side effects reported in the clinical trial

Vaginal burning: 18%

Vaginal itching 15%

UTI 9%

Yeast infection 9%

Bacterial vaginosis 8%

Male partner reporting local discomfort 10%

Regarding your question of whether it would be recommended to use in student health along with condoms. Let us compare to use of condoms alone. Condoms protect from sexually transmitted infections (unlike Phexxi) and have a lower failure rate compared with use of Phexxi alone. The typical use failure rate of condoms is 13% and perfect use failure rate is 2%.

So, condoms alone are a better choice than Phexxi alone. But, adding Phexxi to condoms may add contraceptive protection. It is a useful alternative if someone doesn’t want to use a more effective method and a partner will not use condoms.

There is no medical downside to adding Phexxi to condoms. But considerations are: a) hassle of filling prescription b) cost if no insurance c) potential for side effects and d) use of chemicals “not expected to lead to safety concerns” according to the manufacturer.

Phexxi should be covered by insurance, but if it isn’t, it is costly. According to the website GoodRX, one box of Phexxi with 12 applications costs $356.78, and with a GoodRX coupon costs $311.16

DISCLAIMER: This information is for educational purposes only and not intended to guide individual therapy. Answers should never substitute for consultation with a healthcare provider or counselor who can make decisions based on an individual’s history, desires, and circumstances. Always seek the advice of a clinician for any questions regarding health, medical condition, birth control method or other family planning or social issues. Under no circumstances should an individual use this information in lieu of, or to override, the judgment of a treating clinician. Dr. Zieman, or SageMed LLC, is not responsible, or liable, for errors, omissions, or any damage or loss incurred as a result of use of any birth control method or use or reliance on any material or information provided through this website.