60 e-Letters

  • 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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  • Comment on 'Adverse reaction to Nexplanon': author's response
    Farah Chaudhry

    I would like to thank Dr Menon for his comments[1] regarding my recently published letter to the editor[2] entitled 'Adverse reaction to Nexplanon'.

    The breakdown of the skin overlying the middle of the subdermal implant (SDI) extended to the whole distal third almost all the way to the tip. It is possible that the skin overlying this portion of the device was too thin and broke down due to intradermal or superfi...

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  • Comment on 'An emergency contraception algorithm based on risk assessment: changes in clinicians' practice and patients' choices'
    Aisling Baird

    Congratulations to Drs McKay and Gilbert on trying to increase access to emergency contraception (EC) intrauterine device (IUD) and on achieving high rates[1]. Even in Liverpool, UK where we pride ourselves on easy, often immediate, IUD access and where we have long been promoting its effectiveness we only achieve around 5%.

    We have some concerns about the algorithm described in this article.[1] The classificatio...

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  • 'Adverse reaction to Nexplanon'
    Ken Menon

    The case referred to in Dr Chaudhry's letter to the editor[1] is interesting in view of the time after insertion and the nature of the breakdown in the overlying skin. While contamination is likely at the time of insertion of an implant, one would expect this to cause infection early and without an apparent symptom-free latent period. It is likely that the patient would have had some discomfort from the time of insertion t...

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  • Comment on 'Unusual shaped IUS'
    Ken Menon

    Reading Dr Lloyd's letter[1] in the July 2013 issue of the Journal has prompted me to write in on this topic.

    Removal of an intrauterine device (IUD) involves traction on the threads causing the horizontal arms of the device to come together in the narrower lower half of the uterus during its downward movement.

    It is relatively easy for the collar of hormone in an intrauterine system (IUS) to be dislod...

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  • Re:Comment on 'Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism'; author's response
    Johannes Bitzer

    I would like to thank Drs Terplan and Zuckerman for their comments[1] on the recently published position statement,[2] which myself and the other cosignatory authors take very seriously.

    If I may summarise Drs Terplan and Zuckerman's argument: It starts with the assumption that there is now clear evidence proving that levonorgestel (LNG)- and norethisterone acetate (NETA)-containing combined oral contraceptives (...

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  • Comment on 'The policing of abortion services in England'
    Matthew Phillips

    I was deeply saddened to read the opinions of Dr Rowlands in his article entitled 'The policing of abortion services in England' in the April 2013 issue of the Journal.[1] Although the argument is clear that the requirement for two signatures on the HSA1 form is burdensome, and is not seen as necessary by everyone, the article seems to miss a key point. An overriding ethical duty for any clinician is truth telling, with...

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