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Contraceptive Vaginal Gel: What to Know

Medically Reviewed by Nivin Todd, MD on June 08, 2022

When it comes to birth control methods, you’ve got lots of choices to make. That’s especially true when you start thinking about how to use various methods in combination to make sure you can have sex without worrying about getting pregnant or ending up with a sexually transmitted infection. Recently, the FDA approved a new type of birth control. It’s a vaginal contraceptive gel (brand name Phexxi). Here’s what to know before you decide to add it to your regular birth control regimen.

What Is Vaginal Contraceptive Gel?

The vaginal contraceptive gel (Phexxi) doesn’t have any hormones in it. It doesn’t have the standard spermicide nonoxynol-9 in it either. Instead, this gel contains three active ingredients:

  • Lactic acid
  • Citric acid
  • Potassium bitartrate

How Does Vaginal Contraceptive Gel Work?

Your vagina is normally acidic. The gel works by making sure it stays that way when you have sex. The reason this helps is that sperm don’t do well in an acidic environment. So the extra acidity in your vagina keeps sperm from swimming in the way they would otherwise. As a result, you’re less likely to get pregnant.

Phexxi comes in a box of 12 prefilled applicators. You put it in your vagina right before you have sex or up to an hour before. It doesn’t work if you try to use it after sex.

How Well Does Vaginal Contraceptive Gel Work?

A study that tested how well this vaginal contraceptive gel works in women aged 18-35 who used it for 6 months found it was 86% effective. Nearly 14% of women got pregnant. Another study suggests it can work better than this when you use it in an ideal way. Like any birth control method, you have to use it exactly as intended to get the most protection.

Based on these findings, vaginal contraceptive gel by itself works about as well as condoms. It isn’t as good at preventing pregnancy as other methods including:

What Are the Benefits of Using Vaginal Contraceptive Gel?

Vaginal contraceptive gel by itself doesn’t work as well as some other methods to keep you from getting pregnant. But it does have advantages including:

  • You can use it on demand, similar to a condom, and it works about as well for preventing pregnancy.
  • You can use it together with a condom, diaphragm, or spermicides for extra protection against pregnancy and sexually transmitted infections.
  • It’s easy to use, safe, and most women tolerate it well.
  • It doesn’t have any hormones.
  • You can use it only when you need it and it leaves your body quickly.
  • You can easily stop using it if you want to get pregnant.

What Are the Side Effects or Risks of Using Vaginal Contraceptive Gel?

Any form of birth control has pros and cons. Some of the potential downsides of vaginal contraceptive gel include:

  • It isn’t as good by itself in protecting you from getting pregnant.
  • It won’t protect you from sexually transmitted infections. Condoms will.
  • You have to use it every time before you have sex, and it doesn’t keep working for very long.
  • If you are going to have vaginal sex a second time, you need to use it again.
  • It might make your vagina itch or burn.
  • You might get a vaginal yeast or bacterial infection, urinary tract infection (UTI), or have discharge that’s not normal for you.
  • If you get UTIs a lot, you shouldn’t use vaginal contraceptive gel.
  • Your partner might notice burning, itching, or pain on his penis.

How Do I Get the Vaginal Contraceptive Gel?

Your doctor has to write you a prescription to get vaginal contraceptive gel (Phexxi). Note that if you see a box on your drugstore shelf that says it’s a vaginal contraceptive gel, it most likely contains the spermicide nonoxynol-9. You can use this a lot like Phexxi. But these older spermicides don’t work as well to prevent pregnancy. They’re about 71% effective. It’s best to use them along with condoms or other methods.

Phexxi is more expensive than other on-demand birth control methods at $285 a box or $24 per use. But check to see if your health insurance will cover it. By comparison, a box of vaginal contraceptive gel containing nonoxynol-9 costs about $11 or $1 per use. You also don’t need a prescription from your doctor to buy it.

If You Decide to Use Vaginal Contraceptive Gel

If you decide to try vaginal contraceptive gel, make sure you understand exactly how to use it. Your doctor should tell you the following:

  • You need to use a single dose before each time you have vaginal intercourse.
  • If you use it and then end up having sex more than an hour later, use another dose.
  • You should ask your doctor if you feel like it’s causing you severe or lasting irritation.
  • Contact your doctor also if you think you might have a UTI or other infection.
  • Stop using it if you notice a worrying reaction. In rare cases, you could be hypersensitive to it.
  • Vaginal contraceptive gel won’t protect you from sexually transmitted infections including HIV.

Show Sources

SOURCES:

JAMA: “Phexxi—A Non-hormonal Contraceptive Gel.”

American Family Physician: “Lactic Acid, Citric Acid, and Potassium Bitartrate (Phexxi) Vaginal Gel for Contraception.”

Kaiserpermanente.org: “Vaginal gel,” “Spermicide,” “Types of Birth Control.”

Cleveland Clinic: “Spermicide.”

Contraception: “A Novel Vaginal PH Regulator: Results From the Phase 3 AMPOWER Contraception Clinical Trial.”

FDA: “Highlights of Prescribing Information: Phexxi.”

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