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Background Expulsion of an intrauterine device (IUD) occurs in about 1 in 20 women and expulsion may not be noticed by the user. Current guidance recommends that users are instructed to check regularly for their threads. This is the first study to explore the reality of how women feel about checking their threads and the details surrounding how frequently checks are done. Methods One hundred consecutive IUD users were interviewed regarding their type of device, duration of use, frequency of thread checking, prompts for checking and reasons for not checking. Results Only 23% checked their threads regularly and 51% had never done so. The most common reason for not checking was forgetting about it. Conclusions Despite being advised to do so, the majority of users do not check their threads at all and fewer than one-quarter of them check regularly. We propose that advice offered about thread checking should be given less emphasis and suggested more for user reassurance.

Background The National Institute for Health and Clinical Excellence (NICE) has judged Implanon® to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. Methods The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. Results The annual cost for the method (using Implanon) was £77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. Conclusion The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice.

Background The authors9 service has child protection guidance listing locally agreed ‘markers’ of potential abuse and exploitation to aid identification of vulnerable young people. Objectives To review whether staff are identifying markers of sexual abuse and exploitation, and to review documentation relating to assessment of Fraser criteria in under-14s (young people) attending sexual health clinics in Gwent, South Wales, UK. Methods Analysis of case notes of 242 young people who made 598 visits to a sexual health clinic between 1 January and 31 December 2003. Results A total of 81 references to a marker of potential abuse or exploitation were recorded at 8% of visits and for 11% of young people. For 72 references a marker was present and for nine was absent. There was no reference to a marker being present or absent for any young males or for 81% of females. Increasing attendance was associated with increasing prevalence of recorded markers. All young people with three or more markers identified as present were referred onwards compared with 53% of those with one or two markers present. Referral did not deter future attendance. Reference to Fraser guidance assessment was recorded at 35% of visits or for 64% of young people and fully demonstrated at 7% of visits or for 16% of young people. There was no recorded assessment for 18% of females and 60% of males. Conclusions The authors9 service is not recording sufficient information to help identify young people (particularly males) at risk of abuse or exploitation or to demonstrate the service9s compliance with Fraser guidance.

Objectives To determine the gender, sexual history and reason(s) for visit for under-14s (young people) attending the authors9 sexual health clinics. Methods Analysis of case notes of 242 young people who made a total of 598 visits to a sexual health clinic in Gwent, South Wales, UK between 1 January and 31 December 2003. Results Of the 242 young people studied, 41% were male and males were responsible for 42% of visits. There was no written record relating to 7% of the total visits. Median age at both first registration and first heterosexual intercourse (when recorded) was 12 years for males and 13 years for females. Some 57% of females and 30% of males were already sexually active at first registration. Details relating to a young person9s partner and their experience of sex (e.g. willingness, autonomy and consensual nature of sex) were infrequently recorded, especially for males. 96% of males requested condoms and 99% received them, whilst 72% of females requested condoms and/or hormonal contraception and 86% received them. 35% of females were seen for the consequences of sex (i.e. pregnancy testing, emergency contraception, screening and/or treatment of sexually transmitted infections and unplanned pregnancies). 80% of these subsequently received condoms and/or hormonal contraception. The majority of young people saw a nurse exclusively (96% males, 71% females). Conclusions Of the young clients seen, 41% are male. Sexual history details are infrequently recorded, particularly for males. The majority of young people accessing the authors9 service are taking action to protect their sexual health and most will see a nurse exclusively.

Fourteen percent of couples in the UK use vasectomy as their method of contraception.1 Accessing vasectomy services should be made as easy and patient-friendly as possible. Unlike many surgical procedures, it is the patient who decides that it is indicated, not the surgeon. Most men requesting vasectomy are healthy and there are few for whom the procedure is not suitable. Men can assess their own suitability for the procedure with a simple questionnaire, and do not normally need to be examined beforehand. Although the operation carries slight potential for litigation, it has a low risk of serious complications and in most cases the decision on the risk/benefit balance is made by the patient, not a clinician. Preoperative counselling for vasectomy is mostly about providing information. Therefore it could be argued that men wanting a vasectomy should not routinely need to see a clinician preoperatively, and that requiring them to do so does not enhance the patient pathway. Attending an outpatient appointment is inconvenient for the patient, requiring time off work, travel to the clinic, and potentially causing apprehension. The Aneurin Bevan Health Board receives around 900 referrals per annum for vasectomy and most of these are self-referrals. Traditionally we have used structured, preoperative counselling in community-based clinic by doctors and more recently nurses. In a pilot survey, most patients in these clinics thought the information could be provided just as effectively by a DVD. Together with a production company, we produced a DVD that included all the information and advice that local and national guidelines suggest a man should receive before agreeing to a vasectomy.2 We wanted to inform patients fully, enable them to assess their suitability for the procedure and to decide whether or not they were one of the few patients who should be seen for …