Image courtesy of Pixabay.
By Zoë Farr ’21
Managing Editor of Web
For those of us who use birth control, it can feel as though we are constantly on the hunt for the perfect form of contraception to suit our needs. While some feel hesitant about the more invasive forms of birth control, there are some options that can meet your comfort level. On May 22, 2020, the U.S. Food and Drug Administration approved Phexxi, making it the first non-hormonal, on-demand contraceptive that regulates vaginal pH levels. Phexxi is manufactured by Evofem Biosciences, located in San Diego. According to Phexxi’s official website, Evofem Biosciences is devoted to developing innovative healthcare solutions that put women “in control of [their] sexual and reproductive health."
Phexxi is a hormone-free contraceptive that uses active ingredients like lactic acid, citric acid and potassium bitartrate to maintain the vagina’s pH at levels between 3.5 to 4.5, creating a toxic environment for sperm. Phexxi is similar to a spermicide in the sense that it is a gel inserted into the vagina prior to intercourse. However, there’s a key difference between Phexxi and spermicides. According to the National Women’s Health Network, the only FDA-approved spermicides contain a detergent called nonoxynol-9, which damages the cellular membranes of sperm. But prolonged use of N-9 spermicide can damage cells in the vagina as well. Thus, Phexxi provides a safer option for those interested in gel contraceptives since it doesn’t contain N-9.
Phexxi’s position as the first contraceptive of its kind speaks to the larger issue of slowed contraceptive production. Prior to Phexxi, Planned Parenthood outlined that there are 12 major forms of birth control: sterilization, the IUD, the implant, the shot, the vaginal ring, the patch, the pill, condoms, emergency contraception, spermicide, cycle-tracking and the “pull-out” method. Over half of these available forms are hormonal and, as a result, are not suited to everyone's needs.
According to JoJo Zeitlin ’22, co-president of Mount Holyoke College Planned Parenthood Generation Action, the innovation in science and technology surrounding birth control continues, while its profitization gums up the processes of approval and production. Still, Phexxi has persisted, becoming one of the newest hormone-free options and speaking to concerns surrounding the effect of hormones on mental health. “My opinion is that a lot of people on hormonal birth control don’t realize that their mental health symptoms have changed until they’ve gotten off of birth control, and, unfortunately, that can take up to a decade,” Zeitlin said.
If you’re like me and have no idea how much gel you would need to insert to avoid pregnancy, Phexxi is a few steps ahead. According to the FDA, the user administers Phexxi vaginally through pre-filled plastic applicators containing 5 grams of the bioadhesive gel. Up to one hour before sex, the entirety of the applicator’s gel should be inserted and can be used simultaneously with condoms.
According to Planned Parenthood, Phexxi is 93 percent effective at preventing unwanted pregnancies if applied perfectly. However, accounting for human error, Phexxi’s realistic effectiveness is about 86 percent, which is roughly the same prevention rate as condoms. According to Zeitlin, that percentage still leaves about 1 in 6 Phexxi and condom users at risk for unwanted pregnancy. The idea of a perfect application sets an unrealistic standard for users, which allows the brand to market their effectiveness higher than what is actually feasible and create a false rhetoric of security for its users. While condoms are essential to safe sex and birth control is important as well, being aware of your body in the weeks after intercourse is equally important to stop unwanted pregnancies.
Zeitlin heard about Phexxi through the brand’s social media marketing campaign. “I had been getting a lot of ads for it, actually,” Zeitlin said. “It’s been popping up a lot; I’ve seen it on TV [and] I’ve seen a bunch of OB-GYNs and midwives that I follow posting about it. It seems really interesting.” These commercials advertise Phexxi as a “revolution in birth control” since it is hormone-free and only needs to be used prior to intercourse, breaking away from the tracking method of the pill. Like many marketing campaigns for these products, the commercial features women smiling amid bright flashes of color as the voiceover hurries through the list of side effects.
As is the case with all birth control, Phexxi’s side effects are important to note. By managing the body’s pH levels, Phexxi can increase UTI risk, vaginal burning, bacterial vaginosis and yeast infections. Though Phexxi’s website notes that in clinical trials, only about 2 percent of users stopped using the contraceptive due to the side effects, those who experience frequent UTIs are discouraged from using it. Planned Parenthood warns that Phexxi can also cause discomfort in the genital areas of the user and their partner, indicating that one of them may be sensitive to the contraceptive. Compared to side effects from other forms of contraceptives, Phexxi’s appear to be mild and localized to a particular region of the body.
According to Zeitlin, Phexxi could prove to be a neutral avenue for contraception. “I think it’ll be kind of like a middle-ground birth control if you will. It’s definitely not going to be the pill, it’s not going to be condoms, but it also isn’t going to be spermicide or NuvaRing or the patch, even,” Zeitlin said. “I think it’ll probably [be] a middle ground. Some people will use it, but it’s definitely not going to be good for everyone.” However, social media will definitely be significant to the public reception of Phexxi.
“There’s a lot of social media influence around birth control, and a lot of anecdotal experiences being put out there that are really influencing the general population’s opinions, feelings and thoughts,” Zeitlin mused. “The idea sticking out to me, in particular, is that there are horror stories about [birth control] all over the internet. The actual likelihood of anything … going wrong is extremely low, but you’re gonna hear about it because it’s terrifying when it happens.”
This particular comment struck a chord with me, as I have Kyleena, a hormonal IUD that I don’t need to replace until 2025. Prior to receiving my IUD, I was bombarded with stories of IUDs gone wrong, of individuals ending up in emergency rooms or pregnant despite going through the ordeal that is IUD insertion. It felt like everywhere I looked to learn more about the IUD, someone was there with a warning sign telling me how it could all go wrong. While the insertion process wasn’t exactly the time of my life, I believe that, in the long run, it has been an important measure to stop something I really wouldn’t enjoy: being pregnant.
Yet, most forms of birth control are a privilege in the United States, and Phexxi is no exception. An individual hoping to use Phexxi would have to rely on a general physician or gynecologist for a prescription, making Phexxi inaccessible to all class brackets in the country. According to GoodRx, the list price for a box of 12 Phexxi applicators would be $267.50, a high price for uninsured individuals. Planned Parenthood notes that spermicides are sold over the counter despite the fact that they can increase infection and make individuals who use them more susceptible to STIs like HIV.
This contrast between availability and risk opens a dialogue on the inaccessibility of safe contraception for everyone. “There aren’t enough … options for everyone, and it can take a lot of trial and error to find your best option,” Zeitlin said. “This assumes a certain level of privilege — that you can continually try and test various methods until you find one that’s right for you, which requires more doctor’s visits, more trips to the pharmacy and more prescriptions you have to pay for.”
“The fact that Phexxi is not [available] over the counter is weird to me, but I do have a feeling that it will be … at some point. Since it’s still new, they’re still testing it,” Zeitlin explained.
In the meantime, Phexxi opens up an avenue for new birth control products in the 2020s, expanding the available birth control market and diversifying options for birth control users. If you’re interested in trying Phexxi, reach out to your local clinic, your general physician or your gynecologist to give it a shot.
To learn more about Zeitlin and MHCPPGA’s advocacy for reproductive health rights and resource distribution for the Mount Holyoke College community, check out their page on Instagram, @MHCPPGA.