For women interested in birth control methods, one factor they may consider is whether the option is hormonal or non-hormonal. Examples of hormonal birth controls include the birth control pill, birth control implant, birth control injection, and most forms of IUDs (or intrauterine devices). Non-hormonal options including condoms, spermicide, and the copper IUD.
Some women have medical conditions that prevent them from using any hormonal forms of birth control. Other women may just prefer to use a method that does not contain hormones. This year the FDA approved a new non-hormonal birth control method—a vaginal gel that is inserted just prior to intercourse. The new product is a combination of lactic acid, citric acid, and potassium bitartrate and is marketed with the brand name Phexxi.
Phexxi prevents pregnancy by maintaining an acidic pH in the vagina. During unprotected sex, semen causes an increase in pH, making the surrounding more alkaline (opposite of acidic), protecting the sperm from the more acidic vaginal environment.
When Phexxi is inserted, it coats the walls of the vagina and keeps the pH between 3.5 and 4.5. This acidic environment immobilizes the sperm. This method of action is a little different from a spermicide, which is a non-hormonal contraceptive that has been available for decades. Most over-the-counter spermicides contain nonoxynol-9, which kills sperm by damaging the cell membrane of the sperm.
Phexxi comes in a pre-packaged applicator that is similar to a tampon applicator. The gel is inserted right before intercourse or up to 1 hour before intercourse. It is necessary to reapply the gel with every act of intercourse, no matter the timing between each act. The gel can be used with other methods of contraception, including condoms or diaphragms. However, it should not be used with the vaginal ring contraceptive device.
Phexxi was found to be 86.3 percent effective at preventing pregnancy in the clinical trial that was assessed for FDA approval. This is similar to the efficacy of condoms at preventing pregnancy, which is about 85 percent effective. A small number of women in the study had severe urinary tract infection and kidney infection after using the gel, so it is not recommended for women who have a history of recurrent urinary tract infections. The most common side effects include vaginal itching, burning, yeast infection, bacterial vaginosis infection, and pain with urination.
While spermicides are available over the counter, the new vaginal pH gel contraceptive is only available with a prescription. Another difference between this new medication and traditional spermicides is timing of insertion. Some spermicides can be used right before intercourse, while other preparations need to be inserted 10 minutes prior to intercourse to be effective. Phexxi can be inserted just prior to sex and no wait time is needed.
The active agent in spermicides can be damaging to the cells in the vagina, and while it is safe to use, some women do find spermicides to be irritating, especially with frequent or prolonged use. Based on its different method of action, it is not expected for Phexxi to have this same effect on vaginal cells. Neither spermicides nor Phexxi protect against sexually transmitted diseases.
Although Phexxi is not as effective at preventing pregnancy as many hormonal options, it is an innovative new option for hormone-free birth control. Your healthcare provider can give you more information about this option and help you decide if it would be a good method for you.
Emily Nobles, WHNP, is a nurse practitioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. For information, call 757-463-1234 or visit www.atlanticobgyn.com.