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Phexxi

lactic acid / citric acid / potassium bitartrate
Used for Birth Control
Used for Birth Control

Phexxi is a prescription vaginal gel used as a type of birth control to prevent pregnancy. It’s hormone-free, so it doesn’t contain any hormones. Instead, it has three active ingredients: lactic acid, citric acid, and potassium bitartrate. Though it’s not a spermicide, it’s used the same way — by inserting it into the vagina before sex, as needed. Common side effects include vaginal burning, vaginal itching, and yeast infections.

Reviewed by:
reviewer
Daisy Chau, PharmD
reviewer
Connie Zheng, PharmD
Last reviewed on November 13, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostAlternativesLatest newsReferencesPricesMedicare
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What is Phexxi?

What is Phexxi used for?

How Phexxi works

Phexxi is a vaginal pH regulator. It works by changing the pH of the vagina during sex, making the vaginal environment more acidic during sex. This makes it harder for sperm to move up to where the egg is, which lowers your risk of pregnancy.

Drug Facts

Common BrandsPhexxi
Drug ClassContraceptive
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Phexxi essentials

Phexxi: white cream smeared on lavender background 1328326368

How Effective is Phexxi, the Non-Hormonal Birth Control Gel?

Written by Ross Phan, PharmD, BCACP, BCGP, BCPS
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What are the side effects of Phexxi?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Vaginal burning (18%)
  • Vaginal itching (15%)
  • Vaginal yeast infection (9%)
  • Urinary tract infection (UTI) (9%)
  • Vaginal discomfort (9%)
  • Vaginal bacterial infection (8%)
  • Vaginal discharge (6%)

Other Side Effects

  • Genital discomfort
  • Painful urination
  • Vaginal pain

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Urinary tract infection: pain or burning during urination, cloudy urine, pain in the pelvis, back pain

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

  • Vaginal irritation at application site
pros-and-cons

Pros and cons of Phexxi

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Pros

A hormone-free birth control option

Can be used as needed right before (or up to 1 hour before) vaginal sex

Can be used anytime even during your period

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Cons

Must be prescribed by a healthcare professional

Can cause vaginal burning, itching, or discomfort

Doesn't work as well to prevent pregnancy as some other birth control methods

pharmacist-tips

Pharmacist tips for Phexxi

pharmacist

  • Use Phexxi right before or up to 1 hour before vaginal sex. Since this medication is used to prevent pregnancy, stop using it if you become pregnant, as it’s no longer needed.

    • You can use Phexxi at any time, including while you’re on your period. Just make sure you use a new single dose applicator each time you have vaginal sex with your partner.

      • It’s okay to use Phexxi as soon as your OB-GYN provider says it's safe to have vaginal sex after childbirth, abortion, or miscarriage.

        • Phexxi doesn’t protect you against HIV and other sexually transmitted infections (STIs). Talk to your prescriber if you have questions about ways to protect yourself from these infections.

          • If you're allergic to any ingredients in Phexxi (lactic acid, citric acid, or potassium bitartrate), you might also be allergic to the medication itself. Mild side effects like local burning, itching, and pain can occur, and your partner might experience these too. Let your prescriber know if these symptoms become bothersome.

            How to use Phexxi:

            • It’s important to read the Instructions For Use before using Phexxi to make sure you use it correctly.

              • Take the applicator and plunger out of the foil wrapper. Insert the plunger into the end of the applicator and slowly push until they connect. Once connected, remove the pink cap.

                • Gently insert the applicator into your vagina. Then, using your index finger, push the plunger down until it stops to make sure all the gel is inserted. Remove the applicator and plunger, and throw them away.

                  faqs

                  Frequently asked questions about Phexxi

                  How effective is Phexxi?
                  In a clinical study, Phexxi was 86% effective at preventing pregnancy, similar to condoms, which are 85% effective. Though Phexxi doesn't work as well as other birth control methods, like an intrauterine device (IUD) or the pill, it's more effective than spermicides. Speak with your OB-GYN provider about the different birth control options available to you.
                  How long does Phexxi last?
                  Phexxi lasts about 1 hour before you have vaginal sex. So if you don’t have vaginal sex within an hour after using the gel, you’ll need to insert a new applicator before having sex. Also, if you have vaginal sex more than once within an hour, use a new applicator each time. Basically, you'll need to use a new Phexxi applicator each time you have vaginal sex.
                  Does Phexxi cause yeast infections?
                  It can. About 9% of people who used Phexxi had a yeast infection in clinical studies. If you notice symptoms such as vaginal itching, yellowish discharge, and pain, let your OB-GYN provider know.
                  Does Phexxi expire?
                  Yes, Phexxi can expire. Look for the expiration date written on the box. Each application can only be used one time as well. Throw away the medication and ask for a refill or new prescription if it's past the expiration date. Expired medication might not work as well to prevent pregnancy.
                  Does Phexxi cause weight gain?
                  Weight gain isn't a side effect reported by people who used Phexxi in clinical trials. Speak with your OB-GYN provider if you have questions about weight gain and this medication.
                  Can Phexxi be used alone?
                  Yes. Phexxi can be used alone or with other birth control methods. Using it with other options can further lower your chances of getting pregnant. Though it's okay to use Phexxi with the pill, condoms, and vaginal diaphragms, avoid using it with a vaginal ring like the NuvaRing (etonogestrel / ethinyl estradiol) or Annovera (segesterone acetate / ethinyl estradiol). Speak to your OB-GYN provider to discuss the best pregnancy prevention for you.
                  Does Phexxi have a generic?
                  No. Phexxi is only available as a brand-name medication.
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                  What are the risks and warnings for Phexxi?

                  Phexxi can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Urinary tract infections (UTI)

                  • Risk factors: Repeated urinary tract infections (UTI) | Other urinary tract conditions

                    Phexxi can raise your risk for urinary tract infections (UTI), including bladder infection (cystitis) and a kidney infection (pyelonephritis). Your risk is higher if you have a history of UTIs or other urinary tract conditions. Even though UTIs are common, they can be serious if left untreated. If you experience symptoms like pain or burning during urination, cloudy urine, pain in the pelvis, or back pain, let your prescriber know or speak to another healthcare professional as you might need antibiotics to treat the UTI.

                    dosage

                    Phexxi dosage forms

                    The average cost for 1 box of twelve 5g applicators of 1.8%/1%/0.4% of Phexxi is $343.15 with a free GoodRx coupon. This is 22.28% off the average retail price of $441.52.
                    box
                    Box
                    DosageQuantityPrice as low asPrice per unit
                    twelve 5g applicators of 1.8%/1%/0.4%1 box$343.15$343.15

                    Typical dosing for Phexxi

                    Phexxi comes in pre-filled single dose applicators. Each applicator contains 5 grams of gel.

                    The typical dose is one pre-filled applicator placed into your vagina right before (or up to 1 hour before) vaginal sex.

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                    Phexxi (brand)
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                    alternatives

                    What are alternatives to Phexxi?

                    There are a number of medications that your doctor can prescribe in place of Phexxi. Compare a few possible alternatives below.
                    Phexxi
                    Used for:
                    $343.15 Lowest GoodRx priceView Prices
                    Paragard (copper IUD)
                    Used for:

                    • To prevent pregnancy

                    View Prices

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                    References

                    Best studies we found

                    Belyayeva, M., et al. (2024). Acute pyelonephritis. StatPearls.

                    Evofem, Inc. (2023). Phexxi- lactic acid, l-,citric acid monohydrate, and potassium bitartrate gel [package insert]. DailyMed.

                    Thomas, M. A., et al. (2020). A novel vaginal pH regulator: Results from the phase 3 AMPOWER contraception clinical trial. Contraception: X.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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