It is after the experience of my straw poll of 250 general practitioner (GP) and family planning doctor inserters at an update session showed over 90% of us do not even offer injectable local anaesthesia (ILA), and finding this reflected in seminars, updates and training sessions with GPs mostly in the Southern parts of England, that I have based my current position. Of course, as Dr Bacon1 and even Dr Jones2 maintain, day-to-day events affect the patient as we can by our approach, our understanding and empathy – we are medical professionals because we passionately care about people – but some pains resistant to the likes of vocal local will still need the magic of anaesthesia.

And this is why, to counter all those in our specialty who take it upon themselves to decide for women that they do not need anaesthesia, that I have taken what appears to be the radical position of making ILA the default position. I now say to all women, …