Judging by our respective letters,1 2 Beth Devonald and I appear to work in different worlds.

1. I find nurse practitioners take to learning techniques of anaesthesia with enthusiasm, unlike Dr Devonald's students who are “most anxious” and “heave a sigh of relief” that they won't have to learn how to give local anaesthesia (LA). The nurses I meet have seen women experiencing strong pain with insertions, something Dr Devonald says she does not recognise, and are delighted to learn techniques of avoiding it.

2. LA is indeed simple, safe and painless to administer. Dr Devonald reports that she and other colleagues have patients who find the injections uncomfortable. This is not my experience, where most women feel nothing and a few feel an odd sensation or dull ache. This minority who feel something report that it is not painful and is certainly less than the discomfort of dental anaesthesia or LA for insertion of a subdermal implant. If this is the case, what then am I doing that …