• intrauterine devices

We are grateful to David Horwell for responding to our article1 with a letter2 and a photograph of his favoured forceps – the Judd-Allis.

It was not our intention to suggest that the Littlewoods forceps are superior to any other type of atraumatic forceps. We simply chose Littlewoods forceps because the authors were familiar with their use.

A range of instruments are available for holding the cervix and we chose two examples that are routinely used during outpatient gynaecological procedures, anticipating that the single toothed volsellum would cause more bleeding and pain due to the puncture mark that is often visible after applying the tenaculum. However, our study failed to show a significant difference between the types for either bleeding and pain.

Our understanding is that forceps type is often predetermined by the sterile packs that are used, rather than being a positive decision to choose one type over another. However Mr Horwell's comments2 have encouraged us to try a Judd-Allis type in practice to see if it is as good as he suggests.

It would be fascinating to repeat the study using the aforementioned forceps as reducing the discomfort experienced at the time of intrauterine contractive (IUC) insertion is key to increasing uptake and acceptability of IUCs.