Contraception

The prescription spermicide Phexxi is the newcomer to the group, and may be suitable for people who want a non-hormonal method, used on an as-needed basis, with usage controlled by the woman, plus tolerance of a higher failure rate. I've included information about Phexxi in the following table, to introduce you to its characteristics. You can read more about Phexxi here.

Needs a visit to a healthcare provider for a procedure:

A provider can evaluate and write a prescription:

Over-the-counter, non-prescription:

Other alternatives:

Definitions:

• Failure rate
  Usually defined as the percentage of women who get pregnant during their first year of using the contraceptive method.
• Failure rate range
  When shown as a range, the lower number represents Perfect Use and the higher number is for Typical Use failure rates.
• Perfect use
  Represents pregnancies that occurred in women even though they always used their contraception correctly and consistently.
• Typical use
  Represents how the average person uses contraception. These rates apply to women who became pregnant while not always using the contraception correctly or consistently. Many people find it challenging to always use contraception correctly.

About Phexxi:

Medication Form & Strength:

• lactic acid 18mg, citric acid 10mg, potassium bitartrate 4mg per gram.
• 5g prefilled single-dose vaginal gel applicator.
• 12 applicators per box, estimated price $265 per box.

Indication:

• For prevention of pregnancy in females of reproductive potential for use as an on-demand contraceptive method:
  • Apply 1 prefilled applicator (5 grams) vaginally immediately before or up to 1 hour before each act of vaginal intercourse.
  • If more than 1 act of vaginal intercourse occurs within that 1 hour, an additional dose must be applied.

Dosing considerations:

• May be used concomitantly with hormonal contraceptives; latex, polyurethane, or polyisoprene condoms; or vaginal diaphragms.
• AVOID use with vaginal rings.
• May be used concomitantly with other products for vaginal infections, including miconazole, metronidazole, or tioconazole.
• NOT effective for prevention of pregnancy when applied after intercourse.

Drug interactions:

• No interactions found.

Adverse effects:

• >10%. ...
• Vulvovaginal burning sensation (18%).
• Vulvovaginal pruritus (14.5%).
• 1-10%. ...
• Local discomfort in male partners (9.8%).
• Vulvovaginal mycotic infection (9.1%).
• Urinary tract infection (UTI) (9%).
• Vulvovaginal discomfort (9%).
• Bacterial vaginosis (8.4%).
• Vaginal discharge (5.5%).
• Genital discomfort (4.1%).
• Dysuria (3.1%).
• Vulvovaginal pain (2.1%).

Contraindications:

• None.

Cautions:

• Discontinue if hypersensitivity reactions develops.
• Cystitis, pyelonephritis, or other upper UTI may occur.
• AVOID use of in females of reproductive potential with a history of recurrent UTI or urinary tract abnormalities.

Pregnancy & lactation:

• DO NOT use during pregnancy.
• No data available with the use in pregnant females or animals.
• No data available on the presence of lactic acid, citric acid, and potassium bitartrate or their metabolites in human milk, or effects on breastfeeding or milk production.

Mechanism of action:

• Regulates vaginal pH within the normal range of 3.5–4.5, even in the presence of semen, which normally raises the vaginal pH to 7–8.
  • Maintains an acidic environment that is inhospitable to sperm, as well as to certain viral and bacterial pathogens associated with STI's, but is integral to the survival of healthy bacteria in the vagina.

Pharmacokinetics:

• Pharmacokinetic studies in humans have not been performed.
• Systemic exposures of lactic acid, citric acid, and potassium bitartrate following vaginal administration are not expected to lead to safety concerns.

Administration, storage:

• May use during any part of the menstrual cycle.
• May use as soon as it is safe to resume vaginal intercourse after childbirth, abortion, or miscarriage.
• Store in the original foil pack at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF).

References:

• Planned Parenthood Guide on Birth Control
• CDC Guide on Reproductive Health