In May 2021, the U.S. Food and Drug Administration (FDA) approved Phexxi, a new non-hormonal contraceptive. At the same time, innovations in the male contraceptive arena promise even more choices for "on-demand" birth control. Here is a primer for OB/GYNs looking to learn about new developments on both fronts.
Phexxi Effectiveness: What Clinicians Should Know
Made by Evofem Biosciences, Phexxi is a contraceptive gel that can be used in place of traditional spermicides. It works by influencing the natural acidity of the vagina to create an acidic environment that is inhospitable to sperm, according to a fact sheet from the National Women's Health Network. Typically, the vagina is moderately acidic, with a normal pH of 3.5 to 4.5. However, the presence of semen released during intercourse naturally raises the pH to about 7 or 8, which produces a neutral or slightly alkaline environment in which sperm can survive. Phexxi helps counteract this shift by maintaining an acidic environment.
Traditional FDA-approved spermicides contain nonoxynol-9, which works by damaging cells in the sperms' membrane. While nonoxynol-9 prevents pregnancy with estimated effectiveness of about 72 percent, according to data shared by Planned Parenthood, it has also been shown to damage cells in the vagina, putting those who use it frequently at a higher risk for sexually transmitted infections (STIs). Phexxi, on the other hand, contains lactic acid, citric acid and potassium bitartrate, substances naturally found in dairy products, citrus fruits and cream of tartar, respectively. Planned Parenthood estimates the gel's effectiveness at around 86 percent.
It is important to note that Phexxi — which is available in prefilled applicators, by prescription only — must be inserted into the vagina up to an hour before penetrative intercourse. It is not effective when used after sex, nor is it approved to protect against HIV or any other STIs. OB/GYNs should counsel patients on using multiple birth control options, such as a spermicidal gel and condoms, if protection from both STIs and pregnancy is needed.
New Male Contraceptive Options on the Horizon
In addition to Phexxi, a number of innovations in male contraceptives are also in the works. For example, a first-in-human study is expected to start soon for a polymer-based, porous plug that is injected into the vas deferens to block sperm from leaving the body. Similar to intrauterine devices for cisgender women or nonbinary patients with a uterus, this approach is reversible. Another potential product, called the Geldom, is described by parent company Eudaemon as a "next-generation" condom made from hydrogel material with a soft, slippery feel more akin to human tissue than latex or nitrile.
A hormonal contraceptive gel for cisgender men is also undergoing clinical trials, reports UC Davis Health. The formulation uses segesterone acetate to reduce sperm production.
More Options, More Protection
For people who do not want to conceive, contraception should be an integral tool in the OB/GYN's sexual and reproductive healthcare arsenal.
Those who prefer not to use hormonal methods should soon have more options to choose from — and the advent of more innovative (and appealing) male contraceptive approaches means patients and their partners will have the ability to select products that work for their specific needs and desires.
