I read all your columns so I know you’ve already answered a bunch of birth control questions. And yet, here I am with another. I’m burnt out on hormonal b.c. Copper IUDs aren’t an option for me because I have a bleeding disorder. And I don’t want to rely on a partner to put on a condom. I keep seeing ads for Phexxi. I want to know everything about it! How does it work and how well does it work? Also, how much does it cost? I’ve looked for it at the pharmacy a few times but I can’t find it. Can we even get it in Milwaukee yet? Or maybe I’m just looking in the wrong places? In the words of Kim Possible, what’s the sitch?

Phexxi Phriendly

Dear Phriendly,

Huzzah! There is a new form of birth control on the market and we’re going to talk about it. You are the fourth person to ask me about this in the last week so this is the perfect time. Those Phexxi ads with Annie Murphy are pretty compelling, aren’t they? And I’m always excited when there are advancements in contraception because it means more options to enjoy our sexuality without unwanted pregnancies. But not all forms of contraception are created equal, so let’s dig in and check this one out.

Phexxi is a vaginal suppository that comes preloaded in an applicator (similar to over the counter medications for yeast infection). It’s a little thick and sort of creamy beige in color. The warmth of the vagina causes it to thin out considerably a few minutes after application.

With “perfect use,” Phexxi is about 93 percent effective at preventing pregnancy. In this case, perfect use means that it’s applied 60 minutes or less before penis-in-vagina sex, and that there is no contact between the penis and the vagina before that. It also means that you apply a second (or third, or fourth—you get the idea) if you’re going to have sex again. Humans being human means that it’s pretty rare to achieve “perfect use,” in which case we can think of Phexxi being about 86 percent effective for the general population. It’s important to note that Phexxi is not at all effective if used following penis-in-vagina sex.

The function of Phexxi is similar to spermicide, but with some important differences. According to Planned Parenthood, spermicide is used inside the vagina, and it “prevents pregnancy two ways: blocking the entrance to the cervix so sperm can’t get to your egg, and stopping sperm from moving well enough to swim to your egg.” Phexxi is different in that it works by maintaining an acidic environment in the vagina, which makes the vagina less hospitable to sperm. The pH in the vagina is typically between 3.5 and 4.5, which is pretty acidic, and sperm can’t survive at that pH. During penis-in-vagina sex, semen temporarily makes the vaginal environment much more basic, changing the pH to more like 7 to 9, which allows the sperm to stay alive and start the journey through the cervix and into the uterus. Phexxi keeps the vaginal pH in its typical range, shortening the sperm’s lifespan substantially and inhibiting its ability to swim toward a waiting egg.

Phexxi’s active ingredients (lactic acid, citric acid, and potassium bitartrate [also known as Cream of Tartar]) are the key to keeping the vaginal environment acidic. These ingredients also mean that Phexxi is going to taste pretty tart if it gets into your mouth, though it wouldn’t be harmful if ingested in the small quantities that are typical with oral sex.

While less than about two percent of people experienced uncomfortable side effects from Phexxi, it can still happen. For some people, the active ingredients will also cause stinging or even burning. Even though the vagina is typically acidic, additional acidic agents might be a little too much. There can also be burning when you pee after sex following the use of Phexxi, as well as general discomfort in the urogenital area (vulva, vagina, urethra and perineum/taint). It’s also probably not a great form of birth control for people who have recurring BV (bacterial vaginosis), yeast infections, or UTIs as Phexxi increases the risk of all of these things (about 0.36 develop UTIs or kidney infections following use of Phexxi).

And I would be shirking a large part of my duty as a sex educator if I didn’t point out that Phexxi does not prevent STIs at all, in any way. That means that many people who may be interested in using it should still use a condom for all penis and vagina sex (as well as proper barriers for all other sexual contact).

The reason you haven’t seen it in the aisles at the drug store is that Phexxi is available by prescription only. Since it’s so new, not all doctors feel comfortable prescribing it yet. However, you can have a virtual visit with a doctor through the Phexxi website to obtain a prescription if you want to try it out. The price tag is fairly hefty ($250 – $300 for 12 applications), and not all insurances are willing to cover it yet. Phexxi offers a discount program (also through their site) for people with limited income. Unfortunately, they’re not very transparent about the income guidelines so it’s hard to know who will qualify. Phexxi has also applied for ACA status as a fully covered prescription birth control, but there’s no forecast on when or if that status will be granted.

When people ask me what I think about Phexxi (and they do!), my answer is sort of complicated. It’s sort of like Annie Murphy’s alter ego singing “A Little Bit Alexis.” I was prepared to be wowed, but ultimately I was amused in a different way. My overall take is that Phexxi may be a decent option for some folks who are trying to avoid pregnancy. I appreciate that someone is putting money into research and development of new methods of birth control. But also, it’s 2022 and it just seems like there should be better, safer, less cumbersome options by now. People who are able to get pregnant should have access to birth control that allows us to live up to our fullest sexual potential without risking a pregnancy. Expensive, prescription-only, 86-percent-effective options that continue to place the onus squarely on our shoulders (or uteruses) are just not doing it for me.

Curious about cunnilingus? Anxious about anal? Do you have questions about queefs or problems with your prostate? Lucky Tomaszek is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee’s only mission-driven, education-focused sex toy store. Send her an email at [email protected] and she’ll get back to you with an answer.

About The Author

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Lucky Tomaszek, LM, CPM, is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee's only mission-driven, education-focused sex toy store. Most mornings you can find her balancing her cat and her keyboard in her lap, working to make the world a smarter, safer place for people of all genders and orientations.