56 e-Letters

  • Comment on 'Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives'
    Mary Pillai

    Congratulations are due to the authors for producing much needed guidelines.[1] These are necessarily a consensus owing to the lack of quality studies on pharmacological interventions. Since 2009 I have provided a referral service for intrauterine device (IUD) problems, and currently manage 400-500 referrals per year for failed insertion or removal, or a history of severe pain and/or vasovagal syncope (VVS). Women referr...

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  • Entonox for the relief of pain or anxiety during IUS/IUD fitting
    Eppy Sewell

    Following a 7-month trial on the use of Entonox for the relief of pain or anxiety during intrauterine device (IUD) or intrauterine system (IUS) fitting, we now offer this method of pain relief to all women attending for an intrauterine procedure. It is available to any patient who wishes to use it but its use is entirely optional. Entonox can be used alongside other analgesics and there is no need for the woman to decide...

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  • Comment on 'Abortion care services delivered from a community sexual and reproductive health setting: views of health care professionals'
    Philip Kell

    We read with interest the article by Michie et al. in the October 2013 Journal.[1]

    We are delighted that our colleagues at a sexual and reproductive health meeting are supportive of the concept of running an abortion service from a community setting. In Torbay we have been running such a service for some years originally delivered by BPAS and now delivered, for the last 12 months, by the integrated Torbay Sexual...

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  • Comment on 'Embracing post-fertilisation methods of family planning: a call to action': authors' response
    Elizabeth G Raymond

    Dr Gordon is uncomfortable with a family planning method that exerts its effect after fertilisation.[1] However, a new study, published after our personal view article was already in press, suggests that many women feel differently.

    This study surveyed 1137 women from randomly selected households in five European countries in 2008.[2] Overall, 41% of the respondents said they would consider using a method that...

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  • Comment on 'Embracing post-fertilisation methods of family planning: a call to action'
    Sandra Gordon

    While acknowledging that the article 'Embracing post-fertilisation methods of family planning: a call to action' [1] is a personal view, the authors appear to assume that readers of the Journal will agree and be motivated to promote such methods. I would like to voice the view that I and many others would find this unethical. This is a price too high to pay to in our desire to help prevent unplanned pregnancies.


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  • Comment on 'Vasectomy: replacing the preoperative outpatient appointment with a DVD': authors' response
    Amanda Davies

    We thank Drs Chukwu and Menon[1] for their interest in our article,[2] and are pleased to hear that their DVD is as popular with the patients as ours is.

    We also started out requiring men who had a history of previous scrotal surgery to come for an appointment prior to their vasectomy. This was in order to carry out an examination to check that the procedure was likely to be possible under local anaesthetic. Ho...

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  • Comment on 'Infections post-Nexplanon fit'
    Farah Chaudhry

    I was very interested to read about Drs Partridge and Bush's experiences with subdermal implant infections.[1] In particular the photographic images were strikingly similar in appearance to the features I observed in the case described in my recent letter to the Journal.[2]

    It is interesting that all three cases described occurred in patients with pre-existing eczema. This feature was not shared with my patient w...

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  • Comment on 'Vasectomy: replacing the preoperative outpatient appointment with a DVD'
    Ken Menon

    The article by Amanda Davies and Charlotte Fleming[1] describes what we have been practising for many years.

    We have run a direct access service dealing with over 4000 patients. The service has been well received with 96% of a sample grading it as good or excellent.[2]

    We do not see the need for a preoperative consultation and agree with the authors that this does not add any quality to the service or th...

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  • Comment on 'An emergency contraception algorithm based on risk assessment: changes in clinician's practice and patient choices': authors' response
    Rebecca J McKay

    We thank Drs Baird and Webb for their considered response [1] to our article [2] and for opening up a constructive debate on provision of different methods of emergency contraception (EC).

    We are aware of the evidence regarding the relative efficacies of the three EC methods and that Faculty of Sexual & Reproductive HealthCare (FSRH) guidance [3] is that all women, subject to eligibility, should be offered a...

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  • Comment on 'The policing of abortion services in England': author's response
    Sam Rowlands

    I write in response to Dr Phillips' letter to the editor[1] that comments on my article[2] in the April 2013 issue of this Journal.

    Despite any criticism of the system regulating abortion from a health care and patient safety point of view, of course clinicians must conduct themselves in accordance with case law, primary legislation, secondary legislation, Department of Health directives and guidance from their...

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