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Objective To measure agreement between the client9s and the clinician9s responses to questions regarding client history as answered on a questionnaire based on the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) for combined hormonal contraception (CHC). Methods Clients aged 18 years and over, attending a central London community contraceptive clinic requesting a repeat supply of CHC, completed a history questionnaire and an evaluation form. Clinicians then completed their copy of the same questionnaire during the consultation. Percentage agreement and the Kappa statistic were used to assess the level of client—clinician agreement. Results Data from 328 client—clinician pairs were analysed. Agreement was above 93% for all identified risk factors. There was complete agreement for thrombosis, diabetes, stroke, cancer and liver problems. Least agreement was noted in the recording of migraine and abnormal bleeding. For all risk factors except smoking, the proportion of clients reporting a risk factor was more than the proportion of clinicians reporting a risk factor. No clinically important information relevant to a particular client9s use of CHC was missed and none of them would have been wrongly prescribed the CHC based just on their self-completed questionnaires. Most women (97%) were happy with this method of history taking. Conclusions A self-completed history questionnaire is acceptable to women and can potentially replace traditional routine medical history taking for continuing CHC. Women completed the questionnaire with a high degree of reliability. There was complete client—clinician agreement on UKMEC Category 4 criteria. Overall, clients reported more risk factors than clinicians, which increases the safety of the questionnaire.

The Margaret Pyke Centre is an integrated sexual health service with up to 500 attendances a week and 200 procedures performed per month. The majority of the procedures carried out in the service are related to the provision of intrauterine contraception (IUC). Anxiety has been shown to contribute to higher levels of pain perceived during procedures such as IUC insertion.1 Distraction during the procedure may help in reducing anxiety and consequently pain. For example, during IUC insertion, verbal distraction, popularly referred to as ‘verbal anaesthesia’ or ‘vocal local’, can be provided by an assistant, or the patient could be advised to hold a small warm water bottle or chemical warming pack inside a disposable cover to the suprapubic region.2 We thought of a different way of distracting patients during procedures. Patients had previously reported that static pictures on the ceilings in our clinic rooms were helpful. As a result of a charitable donation, in September 2013 the service installed televisions (TVs) in three clinic rooms where procedures such as IUC insertions are performed. The aim was to give patients the choice to watch and/or listen to something during their procedures. TVs are already successfully used during dental procedures and paediatric phlebotomy, but their use has not been reported during procedures in sexual health. The service was changing sites and the opportunity was used to install a TV on the ceiling, directly above the examination couch in the rooms (figure 1 …

Cervical endometriosis is usually a retrospective finding on histology. We describe the diverse symptomatology of the disease, wherein a suspicion of diagnosis may be raised. A series of five patients with cervical endometriosis confirmed on histology was identified. One patient was asymptomatic but examination revealed a mass arising from the cervix. Two patients presented with persistent postcoital bleeding, one patient with intermenstrual bleeding and one patient with both intermenstrual and postcoital bleeding. All patients were followed up with colposcopy and cervical biopsy. Persistence of symptoms determined the mode of treatment which included surgical management in the form of large loop excision of the transformation zone (LLETZ) biopsy in four patients. Cervical endometriosis is a benign condition which may present with symptoms such as persistent post-coital bleeding or intermenstrual bleeding. Colposcopy and cervical biopsy are pivotal to the diagnosis. This condition can be managed expectantly in asymptomatic patients and persistent symptoms may warrant surgery.