At a recent Margaret Pyke update, among more than 200 general practitioners and family planning clinic doctors, it was apparent that less than 5% use injectable local anaesthesia (ILA) for their intrauterine device/intrauterine system (IUD/IUS) fittings. As we now profess to be patient centred, this is difficult to comprehend.

There are many reasons doctors choose not to use ILA nor even, against Faculty guidance, to offer it. These range from “no time”, “the pain only lasts a short time” to “I am so good I don't cause pain”. Some believe the injections to be more painful than the insertion and even the attitude that women …