Birth Control Gel: Effectiveness and How It Works

There’s a new birth control option in town: birth control gel. And it offers some notable advantages. Ob/Gyn Emily Freeman, DO, explains what birth control gel is, how it works, and the pros and cons of using this contraceptive method.

What is birth control gel?

“Birth control gel is a newer, [U.S. Food and Drug Administration] FDA-approved form of contraception. It goes by the brand name Phexxi®, and it’s a gel you put inside your vagina,” says Dr. Freeman.

Birth control gel differs from spermicide, though both are dissolvable inserts that prevent pregnancy. “Birth control gel and spermicide affect the sperm’s ability to move and stay viable in your vagina,” she explains. “But they work differently. Spermicide acts as a detergent, dissolving the membrane on the outside of sperm to destroy it. Phexxi affects the acidity of your vagina, which causes changes to sperm.”

How does birth control gel work?

pH levels in your body (like on your skin) describe how acidic or basic the body part is. “Contraceptive gel is a vaginal pH modulator. It changes the pH of your vagina during and after sex,” Dr. Freeman further explains. “Your vagina is normally in an acidic range, which could harm sperm. When you have intercourse with someone who produces semen, the semen causes your vaginal pH to increase to a basic range.” This change from an acidic to a basic environment is how sperm survive inside the vagina.

Phexxi contains three different acids to stop that process. Placed inside your vagina, these acids short-circuit the effect of semen by keeping the vagina acidic. An acidic environment immobilizes sperm so they can’t swim into your uterus to fertilize an egg. This sperm immobilization is how birth control gel prevents pregnancy.

But acids in your vagina? Wouldn’t that sting a little?

No, thank goodness.

The acids in the gel are gentle and occur naturally in your vagina. “Most people who use the gel don’t have any problems, though vaginal irritation is a possible side effect,” notes Dr. Freeman. “If you do have some irritation, it typically gets better over time as you continue to use the gel.”

She also cautions that people with a history of recurring urinary tract infections (UTIs) may not want to use birth control gel. Studies didn’t show that using Phexxi increases UTI risk, but the studies also didn’t include people who already had a history of recurrent UTIs. “So, while we don’t know for sure, currently, it’s advised not to use Phexxi if you have a history of recurrent UTI,” she adds.

Contraceptive gel effectiveness

“When we think about how well a particular contraceptive method works, we talk about ‘typical use’ and ‘perfect use,’” clarifies Dr. Freeman. Typical use is the average user’s experience, where you may not use the contraception perfectly as designed or directed. But even with typical use, birth control gel is an effective contraceptive.

How effective is birth control gel at preventing pregnancy?

• Typical use has 86% effectiveness: In one year of using Phexxi, about 14 out of 100 people have an unintended pregnancy.
• Perfect use has 93% effectiveness: In one year of using Phexxi perfectly, about 7 out of 100 people have an unintended pregnancy.

In comparison, the contraceptive effectiveness of typical use of condoms is around 80%. In other words, 20 out of 100 people would have an unintended pregnancy during one year of condom use.

Pros of birth control gel

You have lots of options for birth control, so what makes contraceptive gel unique? Here are some of the most significant benefits of using birth control gel for contraception:

• It allows for flexible timing. You can insert the gel up to one hour before sex.
• The gel doesn’t contain hormones. Some people have a preference or medical reason to avoid hormone-based contraception.
• It’s easy to use. It comes in a box of 12 prefilled, single-use disposable applicators.
• There’s a lower risk of irritation than you have with spermicide. Birth control gel typically doesn’t irritate vaginal tissues as much as spermicide contraceptives.
• It’s on-demand birth control. Unlike the pill, shot and some other contraceptives, you only use the gel when you need it.
• The gel has pleasure-positive features. The gel can act as a vaginal lubricant, enhancing sensation and pleasure.
• It plays well with others. You can use the gel along with any other birth control method for increased effectiveness.
• The gel works fast. Once the gel is inserted, it works immediately as a contraceptive. Again, you can insert it up to an hour before intercourse.

Cons of birth control gel

Phexxi has many pros, but there are a few drawbacks. Birth control gel:

• May cause vaginal irritation.
• Provides no sexually transmitted infection (STI) protection. Only a condom can protect against STIs.
• Requires a prescription and may not be covered by insurance.
• You need to use a Phexxi applicator every time you have sex. So, you may go through multiple applicators in an evening.

How to use contraceptive gel

As long as you get the timing right, using birth control gel is no more complicated than inserting a tampon. Up to an hour before intercourse, use a prefilled applicator to insert the birth control gel into your vagina. You need to use a new applicator each time you have sex. If you have any questions about using the gel, follow the manufacturer’s instructions or ask your provider.

Can you use birth control gel with other contraceptive methods?

“Yes, one of the biggest benefits of birth control gel is that you can use it with other birth control methods,” says Dr. Freeman. “While gel is effective on its own, using multiple methods can increase the overall effectiveness of your birth control.”

With such ease of use and low risk of side effects, it would be nice to get Phexxi without a prescription. Is that a possibility?

“It would be great if birth control gel were available over the counter like spermicide,” she ruminates. “My hope is this will happen eventually.”