Contraceptive Pearl: Contraception During COVID-19: Acidifying Contraceptive Gel

In May, 2020, the FDA approved a new contraceptive gel containing lactic acid, citric acid, and potassium bitartrate. The brand name is Phexxi. The gel acidifies the vagina, creating an environment that’s hostile to sperm. The gel does not contain nonoxynol 9, the active ingredient in spermicides (which can irritate the vagina and raise the risk of contracting HIV and other sexually transmitted infections).

The acidifying gel is available only by prescription. Each box contains 12 applicators filled with 5 grams of gel. Users insert one 5-gram dose within one hour prior to each episode of vaginal intercourse. Without insurance coverage, the gel costs about $250-275 per box. Certain insurance providers have put the acidifying gel on formulary at $0 copay under the ACA. Additionally, the manufacturer has a copay assistance program to help eligible patients with coverage gaps.

Among 2,804 participants in 2 studies, the most common side effects were vaginal burning (18%) and vaginal itching (14%). Urinary tract infection occurred in 9% of participants. Fewer than 2% of research subjects stopped using the method due to side effects. The contraceptive gel has an efficacy of approximately 85%: that’s higher than spermicide and lower than the external condom.

Although the acidifying gel is quite expensive, it fills the need for a topical, patient-controlled contraceptive that does not contain nonoxynol 9.



Highlights of Prescribing Information. FDA website. Accessed September 8, 2020.

Contraceptive Phexxi Gel Fact Sheet. National Women’s Health Network website. Accessed September 8, 2020.



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.


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