The following Online Firsts have been published

Does a full bladder assist insertion of intrauterine contraception?: a randomised trial (Cameron, Glasier, Cooper,  Johnstone)

Cameron and colleagues set out to answer a simple question: does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful.

Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives (Briggs, Praet, Humphreys, Zhao)

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHC). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had Category 3 or 4 risk factors, particularly BMI ≥35. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower risk alternatives.

Understanding barriers to sexual health service access among substance-misusing women on the South East coast of England (Edelman, Patel, Glasper, Bogen-Johnston)

This interesting article explores why substance-abusing women have problems accessing SRH services in Hastings, UK. Drug use, low self-esteem and previous traumatic experiences all combine prevent women accessing help. This is a qualitative interview study and provides important insights into the care of these women; there are no easy answers but the authors have provided some suggestions as to how practitioners may make the service more accessible.

Coping after recurrent miscarriage: uncertainty and bracing for the worst (Ockhuijsen, Boivin, van den Hoogen, Macklon)

Pregnancy loss is a significant trauma for women, the more so if repeated.  In their study, Ockhuijsen and her colleagues investigated the ways in which women coped in the time after single and recurrent miscarriages and in the difficult period soon after conception while waiting for ongoing pregnancy to be confirmed. They found that coping strategies differed between the two groups of women and they investigated the use of a simple psychological support tool, the Positive Reappraisal Coping Intervention, that may be of help, particularly to those with greater concern for the future following recurrent miscarriage.

The role of ambulatory hysteroscopy in reproduction (Robinson, Cooper, Clark)

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review summarises the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation.

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK (Akintomide, Sewell, Stephenson)

What to do now? How women with breast cancer make fertility preservation decisions (Snyder, Tate)

A service-based approach to nurse training in sexual and reproductive health care (Shawe, Cox, Penny, White, Wilkinson)

Increasing male participation in the uptake of vasectomy services (Singh, Mishra, Alam, Pandey)

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia
(Abdala, Hansen, Toussova, Krasnoselskikh, Verevochkin, Kozlov, Heimer)

Plus Organisation Factfiles on Tommys and the College of Sexual and Relationship Therapists (COSRT) by Susan Quilliam and a letter to the editor “Learning from Romanian women’s struggle to manage their fertility” by Ann Furedi following the article in the January Journal