• long-acting progestogens

We were most interested to read the letter1 from Martyn Walling about the insertion technique for the etonogestrel implant. We too have adopted his technique of injecting local anaesthetic only at the site of needle puncture and not along the length of the proposed track. We also agree with Walling that after the needle has penetrated the dermis it should be withdrawn until the bevel is seen and then insertion continued after the angle of the needle has been adjusted to parallel to the skin surface. Some argue against the former on the grounds that the insertion will be more painful, but most of the pain experienced is when the skin is penetrated. We have however noticed that the last 1 cm of insertion is, for some unknown reason, often painful at the tip.

We feel Walling did not make himself entirely clear about the reasons for the above techniques. …