You might think that most birth control women use will contain hormones. Think again.
A non-hormonal birth control option called Phexxi, made by the company Evofem Biosciences, was approved by the FDA in 2020. One of the product's commercials takes place inside the vagina (yes!) of "Shit's Creek" actress Anne Murphy. The ad is set to look like a luxurious bedroom, where Murphy is seen roaming around and, ahem, waiting for fun.
How does Phexxi work?
Phexxi
prevents pregnancy by changing the pH of the vagina. A healthy vaginal pH is
between 3.8 and 4.5. When a couple is trying to conceive, sperm will enter the
vagina and raise the pH of the vagina, creating a more favorable environment
for sperm. This makes it easier for sperm to enter the cervical canal and possibly
lead to pregnancy.
Phexxi is a
gel that contains lactic acid, citric acid and potassium bitartrate. When Phexxi
is used vaginally, it keeps the pH of the vagina acidic. This helps prevent
sperm from reaching the egg in the cervix and then the uterus.
"Sperm
never reach the egg to fertilize it because they are unable to exit the
vagina," says Dr. Megan Gray, an OB/GYN with Orlando Health Physician
Associates in Orlando, Florida.
Users of
Phexxi insert the gel through an applicator into the vagina for up to an hour
before they plan to have sex.
This form of
non-hormonal birth control is available by prescription. Without insurance,
Phexxi costs about $270 for 12 applicants. Each applicant has one use. The
website has some discount coupons for users with private insurance. The cost
will vary if you have insurance.
Effectiveness of Phexxi
When used in its entirety – meaning always used before sex, and used within an hour window of that time – Phexxi has an effectiveness rate of 93%. According to Planned Parenthood, when not used to its fullest, it is 86% effective. In other words, 14 out of 100 users will become pregnant using Phexxi and any other birth control methods.
You can increase the effectiveness of Phexxi by using other birth control methods along with it, such as a condom or diaphragm.
To make some comparisons, here are the effectiveness rates for some other forms of birth control, according to the American College of Obstetricians and Gynecologists:
Most effectiveness: a birth control implant, an IUD or sterilization. In 100 women, these methods may result in less than one pregnancy in a year.
Moderate effectiveness: a birth control injection, pill or patch; A vaginal ring, or diaphragm. According to ACOG, there will be 6 to 12 pregnancies for every 100 women who use these methods.
Minimal effectiveness: a male condom, female condom, cervical cap,
sponge, fertility awareness-based methods and spermicide. These are associated
with 18 or more pregnancies in a year for women who use them.
Who Might Want to Use Phexxi?
One advantage of Phexxi is that it increases the number of birth control options available at MemorialCare Orange Coast Medical Center in Fountain Valley, California, but that doesn't mean it's for everyone.
Phexxi may appeal to women who want to avoid hormonal birth control. There can be different reasons why this is important to them:
They find that hormonal birth control has
unpleasant side effects for them, such as mood changes, unexpected bleeding,
and low libido, Dr. Chidera Ijiogu, an OB/GYN, says UTHealth Houston and
Memorial Hermann Hospital.
They may also have another health condition, such as high blood pressure or blood clots, says Dr. Rachel Jensen, a resident of the University of Maryland School of Medicine's Division of Obstetrics, Gynecology and Reproductive Sciences in Baltimore. Hormonal birth control can increase the risk of high blood pressure or blood clots. According to the National Blood Clot Alliance, one in 3,000 women who use birth control pills will develop a blood clot annually. This may be a relatively small number, but it puts women already at an even greater risk of blood clots.
They are looking to take a break from hormonal contraception like the pill. There is no medical reason to do so, but Ruiz has some patients who have expressed this preference.
Smoking and using hormonal birth control can
increase the risk of blood clots.
Here are some patients who may find Phexxi a good option for them:
A woman in her mid-40s who smokes and has a
long distance partner whom she occasionally sees. It may also be that he or his
partner does not like to use condoms. Dr. Mary Jane Minkin, clinical professor
of obstetrics, gynecology and reproductive services at Yale University in New
Haven, Connecticut, sees this person as a potential Phexxi user because of her
low (though not zero) chance of becoming pregnant. ) is likely age. Also, she
should not use birth control pills because she smokes.
A new mother who is breastfeeding. Plus, this
person would be fine with an unplanned pregnancy, Minkin says. According to the
package insert, it is not known whether Phexxi will pass into breastmilk.
However, according to the OB/GYN interviewed for this article, it appears to be
safe for this patient group.
A woman who may not be able to use other
forms of birth control. For example, she dislikes IUDs because of cramping, and
she may want to avoid hormonal-based birth control, such as the pill.
A woman using birth control pills who wish to
add another type of protection against pregnancy. "However, most people
who are attracted to this contraceptive usually wish to avoid hormones,"
Gray tells WebMD.
Who should avoid Phexxi?
Women who are not ideal for Phexxi are:
Also want protection from sexually
transmitted infections. Condoms are the only birth control that protects against
both pregnancy and STIs.
Have frequent urinary tract infections, or
urinary tract or kidney disease. The packaging of Phexxi recommends that women
with urinary tract or kidney disease avoid Phexxi. This is because there is
less chance of getting more UTI or kidney infection with use of the product.
Would be strongly against getting pregnant.
You may forget to use Phexxi within the time
window of one hour before sex.
Want to continue using the vaginal ring.
While Phexxi can be used at the same time as some other birth control methods,
such as condoms, it cannot be used at the same time as the vaginal ring, Jensen
says. This is because vaginal rings are usually made of flexible silicone
rubber embedded with contraceptive hormones. Ruiz explains that Phexxi Gel will
break down the silicone material.
Non-hormonal birth control options
While it may be the only non-hormonal birth control gel, Phexxi is not the only form of non-hormonal birth control available. Other options include:
Copper IUD. This type of IUD differs from the standard ones that contain hormones. However, some women dislike the copper IUD because it makes their periods heavier, says Ruiz.
Cervical Caps. It is a small cap shaped like a sailor's cap that is inserted deep into the vagina to cover the cervix and help prevent pregnancy.
Condoms including male condoms and female condoms.
Diaphragm.
Sponge.
Phexxi Side Effects
Like any form of birth control, Phexxi is associated with some side effects. These side effects are not common, but they include:
Burning and burning where the gel is instilled. This occurs in about 2% of patients.
Bacterial vaginosis.
Pain while urinating.
Vaginal discharge.
a yeast infection.
Sometimes, the male partner may also experience some genital irritation or discomfort from Phexxi.
More serious side effects, such as urinary tract infection or kidney infection, occurred in approximately 0.36% of users.
Seek immediate medical attention if you think you are having an allergic reaction to Phexxi, cautions Ejiogu. Symptoms of an allergic reaction include:
Where the burn has been inserted.
fainting.
Redness.
Difficulty breathing.
Here are some final reminders when considering Phexxi as a birth control option:
If you plan to have sex after the initial one-hour window or you are going to have sex again, you need to be put in the gel again.
Phexxi is not intended to operate outside the initial one-hour time window.
You can still use Phexxi on your period.
If you have sex more than once within an hour, you need to insert Phexxi again.
It does not work if used after sex.
It is fine to use Phexxi while using other vaginal medications to treat yeast infections.
will not protect against STIs such as HIV, hepatitis, syphilis and others
You can use Phexxi with other contraceptive
methods, including condoms and the pill. However, do not use it even when using
vaginal rings.
What is the best birth control without hormones?
The most effective and long-lasting
non-hormonal option is the copper intrauterine device (IUD). Barrier methods
(condoms, diaphragms, cervical caps, or sponges) are sometimes combined with
spermicides to boost pregnancy prevention rates, or spermicides may be used
alone (a less effective option).
Is there a non-hormonal birth control pill?
Unlike combination birth control pills, the
minipill -- also known simply as the progestin-only pill -- does not contain
estrogen. The dose of progestin in the minipill is less than the dose of
progestin in combination birth control
What is the healthiest birth control?
Abstinence is the only birth control that is
100% effective and the best way to protect you from STDs
How do married couples avoid pregnancy?
Couples who have sex correctly and consistently use birth control to prevent pregnancy, for example, the birth control pill may be effective in preventing pregnancy. But if pills are skipped, this is not an effective method. Condoms can also be an effective form of birth control.
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