Phexxi is a brand-name prescription drug that’s a form of birth control. It’s FDA-approved to prevent pregnancy in females* of any age who can become pregnant.

Phexxi is meant to be used before vaginal intercourse. This drug isn’t effective for preventing pregnancy if it’s used after sex.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Drug details

Phexxi contains the active ingredients lactic acid, citric acid, and potassium bitartrate. It helps prevent pregnancy by lowering the pH level of the vagina, increasing its acidity. This makes it more difficult for sperm to swim out of the vagina to reach an egg. For more information, see the “How Phexxi works” section below.

Phexxi comes as a gel inside single-use, prefilled applicators. Using one of these applicators, you insert the gel into your vagina. You can do this right before sex or within 1 hour before sex. Each time you have vaginal intercourse, you should insert a new dose of Phexxi beforehand.

Phexxi is available in one strength: 18 milligrams (mg) lactic acid/10 mg citric acid/4 mg of potassium bitartrate per gram (g) of gel. Each applicator contains 5 g of gel.

FDA approval

In 2020, the Food and Drug Administration (FDA) approved Phexxi to prevent pregnancy. Phexxi is the first prescription gel form of nonhormonal birth control to receive FDA approval. Currently, Phexxi is the only FDA-approved gel form of birth control that works by lowering the pH level of the vagina.

Effectiveness

For information about the effectiveness of Phexxi, see the “Phexxi for birth control” section below.

Phexxi is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

The Food and Drug Administration (FDA) approves prescription drugs such as Phexxi for certain uses. Phexxi may also be used off-label for other purposes. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Phexxi is a form of prescription birth control. It’s FDA-approved to prevent pregnancy in females* of any age who can become pregnant. Females are usually able to become pregnant after they’ve had their first period and up until menopause. This typically happens between ages 12 and 51 years.

Phexxi comes as a gel inside single-use, prefilled applicators. Using one of these applicators, you insert the gel into your vagina. You can do this right before sex or within 1 hour before sex. Phexxi isn’t effective for preventing pregnancy if it’s used after sex. Each time you have vaginal intercourse, you should insert a new dose of Phexxi beforehand.

For more information about how this drug works, see the “How Phexxi works” section below. To learn more about birth control, see the Medical News Today women’s health hub.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Effectiveness for birth control

In clinical studies, Phexxi was effective for preventing pregnancy. For more information on how the drug performed in clinical studies, see Phexxi’s prescribing information.

Phexxi is most effective for preventing pregnancy when it’s used exactly as prescribed. The closer you follow the directions for using Phexxi, the better the drug will work for you. For details about how to use the drug, see the “How to use Phexxi” section below.

Phexxi and children

Phexxi is approved to prevent pregnancy in females of any age who can become pregnant. In general, females are able to become pregnant after they’ve had their first period. This typically happens around 12 years of age.

Clinical studies of Phexxi didn’t include females younger than 18 years of age. So, the effectiveness of Phexxi for preventing pregnancy in adolescents isn’t known for sure. Regardless of age, the effectiveness of Phexxi is expected to be the same for all females who have periods.

If you have questions about using Phexxi given your age, talk with your doctor.

As with all medications, the cost of Phexxi can vary. To find current prices for Phexxi in your area, check out GoodRx.com.


The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Phexxi, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Phexxi, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Phexxi, help is available.

Evofem Biosciences, the manufacturer of Phexxi, offers a copay program that may help lower the cost of its drug. For more information and to find out if you’re eligible for support, call 855-358-6583 or visit the program website.

Mail-order pharmacies

Phexxi may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home. Some Medicare plans may help cover the cost of mail-order medications.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

Generic version

Phexxi isn’t available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Phexxi can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Phexxi. These lists do not include all possible side effects.

For more information about the possible side effects of Phexxi, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Phexxi, you can do so through MedWatch.

Mild side effects

Mild side effects* of Phexxi can include:

* This is a partial list of mild side effects from Phexxi. To learn about other mild side effects, talk with your doctor or pharmacist, or view Phexxi’s patient information.
† In clinical studies, this side effect was reported by females who used Phexxi and by their male partners. (Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.)
‡ For more information about this side effect, see “Side effect details” below.

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Phexxi aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects, which are explained below in “Side effect details,” include:

Side effects in children

Phexxi is approved to prevent pregnancy in females* of any age who can become pregnant. In general, females are able to become pregnant after they’ve had their first period. This typically happens around 12 years of age.

Clinical studies of Phexxi didn’t include females younger than 18 years of age. So, it isn’t known whether the side effects of Phexxi in adolescents are similar to those for adults.

If you have questions about possible side effects of Phexxi given your age, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Side effect details

Here’s some detail on certain side effects this drug may cause.

Burning sensation

Phexxi may cause a burning sensation in the vagina or genital area. This was the most common side effect in clinical studies of the drug. In fact, it was reported by females* who used Phexxi and by their male* partners. To find out how often this side effect occurred in studies, see Phexxi’s prescribing information.

The burning sensation you may experience with Phexxi should be temporary. Washing your vagina or genitals with soap and warm water can help lessen this side effect. This side effect may decrease over time if you continue to use Phexxi.

Using a douche to remove Phexxi from the vagina isn’t recommended. This can worsen the burning sensation and may raise your risk for infections. Douching after using Phexxi during sex can also make the drug less effective for preventing pregnancy. Your body will naturally get rid of Phexxi over time.

Tell your doctor if you experience a burning sensation that doesn’t stop soon after using Phexxi. This could be a symptom of infection. (For more information about infections that can happen with Phexxi, see the “Infections” section below.)

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Itching

You may have genital or vaginal itching while using Phexxi. This was a very common side effect in clinical studies of the drug. Itching was reported by females* who used Phexxi and by their male* partners. To find out how often this side effect occurred in studies, see Phexxi’s prescribing information.

The itching Phexxi may cause should go away soon after the drug is inserted. But if the itching is too bothersome, wash your vagina or genitals with soap and warm water. This side effect may decrease over time if you continue to use Phexxi.

Using a douche to remove Phexxi from the vagina isn’t recommended. This could raise your risk for infections. Douching after using Phexxi during sex can also make the drug less effective for preventing pregnancy. Your body will naturally get rid of Phexxi over time.

Tell your doctor if you experience itching that doesn’t stop soon after using Phexxi. This could be a symptom of infection or allergic reaction. For more information, see the “Infections” and “Allergic reactions” sections below.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Infections

Your risk for several types of infections may increase when using Phexxi. Infections were a common side effect in females* in clinical studies of the drug. To find out how often infections occurred in studies, see the drug’s prescribing information.

Specific infections that may happen with Phexxi include:

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Symptoms of infection

Symptoms will depend on the specific type of infection. But common symptoms of infection may include:

Treatment of infection

If you have any symptoms of infection while using Phexxi, tell your doctor right away. They’ll likely give you tests to check for infection. And if you have an infection, your doctor may prescribe medications to treat it. This can include other medications that are inserted into the vagina.

You can still use Phexxi if you’re using other vaginal medications. Examples of vaginal medications that are used to treat infections include:

  • miconazole (Monistat)
  • metronidazole (Metrogel)
  • tioconazole (Vagistat)

If you have questions about your risk for infection while using Phexxi, talk with your doctor or pharmacist.

Note: Phexxi doesn’t protect you from sexually transmitted infections (STIs). STIs are sometimes referred to as sexually transmitted diseases (STDs). These are infections that are transmitted through sex. To help prevent STIs, you should use Phexxi in combination with a barrier method of birth control, such as condoms.

Allergic reaction

As with most drugs, some people can have an allergic reaction after using Phexxi.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Phexxi, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

You should use Phexxi according to your doctor’s or a healthcare professional’s instructions.

Phexxi comes as a gel inside single-use, prefilled applicators. You use an applicator to insert the gel into your vagina.

Before using Phexxi, unwrap the applicator from its packaging. Then insert a plunger into the applicator and remove the pink cap.

You can insert Phexxi while you’re lying down or standing. To insert Phexxi, bend or spread your knees. Then gently insert the applicator as far into your vagina as it will comfortably go. To make sure you receive the full dose of Phexxi, use your index finger to push the plunger rod until it stops. Then remove the applicator from your vagina.

Each prefilled applicator is meant for single use. You’ll use a new applicator for each dose of Phexxi.

There’s no need to remove Phexxi from your vagina after intercourse, such as with a douche. Your body will naturally get rid of the drug over time. Using a douche to remove Phexxi from your vagina could raise your risk for infections. Douching after using Phexxi during sex can also make the drug less effective for preventing pregnancy.

For more detailed instructions on using Phexxi, visit the drug manufacturer’s website or read the drug’s prescribing information.

When to use

You’ll use Phexxi right before vaginal intercourse. You can insert the drug within 1 hour of having sex. Remember that each time you have vaginal sex, you need to use a new dose of Phexxi beforehand. The drug isn’t effective for preventing pregnancy if it’s used after sex.

Phexxi can be used any time during your menstrual cycle, including the days you have your period.

Talk with your doctor if you’ve recently given birth or had an abortion or pregnancy loss. Phexxi can be used as soon as your doctor says it’s safe to have vaginal sex.

The information below describes the usual dosage of Phexxi. Because the drug only comes in one strength, everyone using Phexxi will receive the same dosage.

Drug form and strength

Phexxi comes as a gel inside single-use, prefilled applicators.

It’s available in one strength: 18 milligrams (mg) lactic acid/10 mg citric acid/4 mg of potassium bitartrate per gram (g) of gel. Each applicator contains 5 g of gel.

Dosage for birth control

You insert Phexxi into your vagina using a prefilled applicator. You can do this right before sex or within 1 hour before sex.

Each time you have vaginal intercourse, you should insert a new dose of Phexxi beforehand. If you have vaginal sex again within 1 hour of inserting the drug, you’ll need to use an additional dose of Phexxi.

Children’s dosage

Phexxi is approved to prevent pregnancy in females* of any age who can become pregnant. In general, females are able to become pregnant after they’ve had their first period. This typically happens around 12 years of age.

The dosage of Phexxi that’s used for adolescents is the same as the dosage used for adults. For more information, see the “Dosage for birth control” section above.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

What if I miss a dose?

Phexxi is meant to be used within 1 hour before vaginal sex. Phexxi isn’t effective for preventing pregnancy if the drug is used after sex. If you forget to insert Phexxi before sex and aren’t using another form of birth control, you may not be protected from pregnancy.

If this happens, you might need to use emergency contraception. An example is the Plan B pill (often called the morning-after pill).

If you miss a dose of Phexxi but aren’t sure whether you should use emergency contraception, talk with your doctor or pharmacist.

Will I need to use this drug long term?

Phexxi can be used as a long-term form of birth control. If you and your doctor determine that Phexxi is safe and effective for you, you can likely use it long term.

There aren’t any known interactions between Phexxi and alcohol.

If you drink alcohol, talk with your doctor about how much alcohol is safe for you to drink while using Phexxi.

Phexxi isn’t known to interact with other medications, herbs, supplements, or foods. The manufacturer of Phexxi didn’t look at interactions in clinical studies of the drug.

This doesn’t mean interactions can’t happen with Phexxi.

Before using Phexxi, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Phexxi is a brand-name prescription drug that’s a form of birth control. It’s FDA-approved to prevent pregnancy in females* of any age who can become pregnant.

Phexxi is meant to be used before vaginal intercourse. Phexxi isn’t effective for preventing pregnancy if the drug is used after sex.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

How does pregnancy happen?

Pregnancy happens when an egg is fertilized by sperm and then successfully implants into the uterus.

Every month during ovulation, an egg is released from your ovaries into your fallopian tubes. The egg remains there until:

  • it’s shed from your uterus during your period, or
  • it’s fertilized by sperm

For fertilization to happen, sperm must swim from the vagina to the fallopian tubes.

How does Phexxi prevent pregnancy?

Phexxi contains the active ingredients lactic acid, citric acid, and potassium bitartrate. It works by lowering the pH level of the vagina to make it more acidic. This is effective for preventing pregnancy because sperm prefer a less acidic environment. A more acidic environment makes it difficult for sperm to swim toward eggs in the fallopian tubes.

How is Phexxi different from spermicides?

Spermicides are a type of birth control. Similar to Phexxi, they’re inserted into the vagina right before sex.

Spermicides are available in different forms, such as creams, films, foams, gels, and suppositories. Contraceptive sponges and some condoms also use spermicides to help prevent pregnancy.

Spermicides work differently from Phexxi. Phexxi changes the pH of your vagina. Spermicides, on the other hand:

  • damage sperm
  • form a barrier that blocks the sperm’s pathway from the vagina to the fallopian tube

Spermicides are available over the counter, meaning you can get them without a prescription. Phexxi requires a prescription from your doctor.

If you have questions about spermicides and Phexxi, talk with your doctor or pharmacist.

How long does Phexxi take to work?

Phexxi starts working to prevent pregnancy immediately. It’s effective for preventing pregnancy as soon as it’s inserted into the vagina.

Phexxi is approved to prevent pregnancy. However, except for abstinence, no birth control method is 100% effective in preventing pregnancy.

In rare cases, it’s possible that you may become pregnant while using Phexxi. This is more likely to happen if the drug isn’t used exactly as prescribed. You should insert a dose of Phexxi into your vagina within 1 hour before vaginal intercourse. The drug isn’t effective for preventing pregnancy if it’s used after sex.

The risks of using Phexxi during pregnancy aren’t known because drug hasn’t been studied in pregnancy.

If you think you’ve become pregnant while using Phexxi, talk with your doctor right away. They’ll likely give you a pregnancy test to see if you’re pregnant.

Phexxi is effective for preventing pregnancy when used by itself. You won’t typically need to use other forms of birth control to prevent pregnancy while you’re using Phexxi.

But to further lessen your chances of becoming pregnant, you could use Phexxi with certain forms of birth control. Examples include:

* An intrauterine device (IUD) is a form of birth control that’s inserted into your uterus by a healthcare professional.

It’s important to note than Phexxi shouldn’t be used in combination with the ethinyl estradiol/etonogestrel vaginal ring (NuvaRing).

Below are a few other forms of birth control that you may or may not need to use with Phexxi.

Phexxi and emergency contraception

Phexxi is not emergency contraception. This type of contraception is used to prevent pregnancy after having sex without using birth control or using birth control that may have failed. But Phexxi isn’t effective for preventing pregnancy if it’s used after sex.

You shouldn’t need emergency contraception if you’ve used Phexxi exactly as it’s prescribed. But if you forget to insert Phexxi before sex and aren’t using other birth control, you may not be protected from pregnancy.

If this happens, you may need to use emergency contraception. An example is the Plan B pill (often called the morning-after pill).

Phexxi and STI prevention

Phexxi doesn’t protect you from sexually transmitted infections (STIs). STIs are sometimes referred to as sexually transmitted diseases (STDs). These are infections that are transmitted through sex.

To help prevent STIs, you should use Phexxi in combination with a barrier method of birth control, such as condoms.

It isn’t known if Phexxi can pass into breast milk during breastfeeding. The effects of Phexxi on children who were breastfed by females* using the drug haven’t been studied.

If you’re breastfeeding or planning to breastfeed, talk with your doctor before starting Phexxi. They can talk with you about the risks and benefits of breastfeeding while using Phexxi.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Here are answers to some frequently asked questions about Phexxi.

Will my partner have any side effects if I use Phexxi?

It’s possible that your partner may have side effects if you use Phexxi.

Phexxi may cause vaginal or genital discomfort. This includes symptoms such as a burning sensation, itching, or pain in the vaginal or genital area. In clinical studies, this side effect was reported by females* who used Phexxi and by their male* partners.

For more information about these side effects, see the “Phexxi side effects” section above.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

If I have sex more than once within an hour, do I need a second dose of Phexxi?

Yes, you’ll need a second dose of Phexxi.

Phexxi comes as a gel inside single-use, prefilled applicators. Using one of these applicators, you insert the gel into your vagina. You can do this right before sex or within 1 hour before sex.

If you have vaginal sex more than once within 1 hour of inserting Phexxi, you need to use an additional dose. Keep in mind that Phexxi is meant to be used before sex. Phexxi isn’t effective for preventing pregnancy if the drug is used after sex. So, make sure you insert a new dose of Phexxi before having vaginal intercourse.

Can I use Phexxi if I’m using other vaginal medications?

Yes, you can use Phexxi if you’re using other vaginal medications.

Phexxi comes as a gel inside single-use, prefilled applicators. Using one of these applicators, you insert the gel into your vagina. You can do this right before sex or within 1 hour before sex.

Using Phexxi can raise your risk for several types of infections, such as yeast infection. (For more information, see the “Phexxi side effects” section above.) These infections may be treated with other medications that are inserted into the vagina. Examples of these drugs include:

  • miconazole (Monistat)
  • metronidazole (Metrogel)
  • tioconazole (Vagistat)

You can still use Phexxi if you’re using other vaginal medications. If you have questions about using Phexxi with other vaginal drugs, talk with your doctor or pharmacist.

Before taking Phexxi, talk with your doctor about your health history. Phexxi may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Problems with the shape or function of your urinary tract. Tell your doctor about any problems you may have with the shape or function or your urinary tract. Your urinary tract includes your bladder, kidneys, urethra, and ureters. Problems with your urinary tract can increase your risk for infections from Phexxi. Possible infections include urinary tract infection (UTI), bladder infection, and kidney infection. For more information about these side effects, see the “Phexxi side effects” section above.
  • UTIs that keep coming back. Before using Phexxi, tell your doctor if you have a history of UTIs that keep coming back. Using Phexxi can raise your risk for several types of infections, including UTIs. Your risk for infections from Phexxi may be even higher if you already experience UTIs that keep coming back. For more information about infections that may happen with Phexxi, see the “Phexxi side effects” section above.
  • Allergic reaction. If you or your partner have had an allergic reaction to Phexxi or any of its ingredients, you shouldn’t use Phexxi. Ask your doctor which other medications are better options for you.
  • Pregnancy. Phexxi is used to prevent pregnancy. The drug isn’t meant to be used during pregnancy. For more information, see the “Phexxi and pregnancy” section above.
  • Breastfeeding. It isn’t known if Phexxi can pass into the breast milk during breastfeeding. For more information, see the “Phexxi and breastfeeding” section above.

Note: For more information about the potential negative effects of Phexxi, see the “Phexxi side effects” section above.

Do not use more Phexxi than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

What to do in case you use too much Phexxi

If you think you’ve used too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Phexxi from the pharmacy, the pharmacist will add an expiration date to the label on the packaging. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good to use can depend on many factors, including how and where you store the medication.

You should store Phexxi at a room temperature of 68°F to 77°F (20°C to 25°C). You may temporarily store Phexxi at temperatures of 59°F to 86°F (15°C to 30°C), such as when traveling.

Keep the prefilled vaginal applicators in their original foil packaging until you’re ready to use them. Avoid storing Phexxi in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Phexxi and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.