As videos describing the procedure as agonizing spread on social media, new guidelines advise physicians to consider various anesthetics.In recent years, the process of getting an intrauterine device, or IUD, has become infamous on social media. Videos of women writhing and crying while the T-shaped contraceptive device is inserted have become macabre online staples.“Unless you’re living under a rock, you’re aware of the issue,” said Dr. Beverly Gray, an associate professor of obstetrics and gynecology at Duke University.Doctors have been accused of ignoring the discomfort. For the first time, federal health officials recommended on Tuesday that physicians counsel women about pain management before the procedure.This updated guidance from the Centers for Disease Control and Prevention may lead clinicians to take the pain more seriously and to consider using anesthetics more often, experts said.“Women’s pain and women’s experiences have been downplayed throughout medicine,” Dr. Gray said.“This is really validating that for some people, this can be a really painful experience.”As the number of women opting for IUDs has risen, so have calls for physicians to address the discomfort associated with the procedure. Some women have described it as “the worst pain imaginable” or likened it to a “hot knife” slowly stabbing them.Effective strategies for managing that pain exist, though a 2019 survey found that few doctors offered those options. Less than 5 percent of doctors offered an injection of a local anesthetic during the procedure, many instead prescribing over-the-counter painkillers, which have been shown to be less effective.A study in 2015 found that doctors tended to underestimate the pain their patients experienced during the procedure.While the last version of the C.D.C.’s guidance mentioned pain management for IUD insertion, Dr. Eve Espey, chair of the obstetrics and gynecology department at the University of New Mexico, said she thought these updated guidelines put a much stronger emphasis on the patient’s preferences and experience.“I think it is a significant change,” she said. “The guidance on this topic has gone from a more provider-centered focus to a more patient-centered focus.” Anxiety about pain may dissuade women from considering the contraceptive, which is safe and highly effective, she added.Dr. Antoinette Nguyen, a medical officer in the C.D.C.’s division of reproductive health, said the new guidance emphasized that choices about pain management should be based on “shared decision making,” taking into account patient experiences that may heighten feelings of pain, like anxiety and past trauma.The new guidelines also broadened the pain-relief options available to women during the procedure, a significant addition since lidocaine shots — the sole anesthetic option mentioned in the 2016 guidance — may themselves be uncomfortable, Dr. Espey said.The choices now include anesthetic gel, creams and sprays. While Dr. Espey said the evidence showing these topical anesthetics are effective was not “fabulous,” the new recommendations still expand the arsenal of tools that doctors have at their disposal.“It’s good when the public stamps it’s foot sometimes,” she said.

Did Dr. Alok Kanojia’s livestreamed conversations with a troubled video game champion cross an ethical line?A few minutes into his first livestreamed conversation with Byron Bernstein, Dr. Alok Kanojia got his caveats out of the way. This was not a therapy session; this was just conversation. Colleagues had warned him, he explained, that blurring the line could get him sued.“I’m a psychiatrist,” he said, “but I can’t treat your depression over the internet.”“Yeah, gotcha,” Mr. Bernstein said.Dr. Kanojia’s fleece jacket bore the logo of Harvard Medical School, where he had done his medical residency. But he had also been a gamer who had followed Mr. Bernstein’s record-shattering career. He beamed at the younger man with undisguised admiration.“So tell me,” he said, clasping his hands together. “What are talking about today, buddy?”Mr. Bernstein, known in the gaming world as Reckful, tweaked the volume on his Twitch feed — thousands of viewers were waiting — and the two men plunged in.The next hour and 53 minutes were intense even by the standards of Twitch, the livestreaming platform where video gamers often field questions about every aspect of their lives. As reactions flooded in, Mr. Bernstein opened up about his older brother’s death by suicide. He spoke about his own suicide attempt, his terrible experience with lithium, the nights he fell asleep wishing he would not wake up.It was a riveting thing to watch: a fragile, brilliant young man opposite a probing, empathic doctor. The two men clearly liked each other, and Mr. Bernstein said he was improving. They had six conversations, with live audiences that climbed into the hundreds of thousands. Then, a few months later, the dialogue ended, tragically, with Mr. Bernstein’s death by suicide at 31.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Getty ImagesSix new regional centres created to support under 18s struggling with their gender identity will open over the next two years, NHS England has confirmed.

More than a decade after her original diagnosis, she suddenly had episodes of losing consciousness. Was this a different type of seizure? “I’m feeling a little stroke-y,” the 33-year-old woman said to her friend Clare as they stood in her kitchen making pizza one evening. Clare looked up from the crust she was stretching. Her words were slurred, and for a moment she just stood there, unmoving, knife in hand. Suddenly she threw the knife up in the air. Her body stiffened, and she teetered. Clare caught her, then eased her rigid body to the floor. The woman’s face was a terrible gray. Her eyes were open but unseeing. Clare crouched beside her, terrified and uncertain what to do. After what seemed an eternity but was probably less than a minute, the body on the floor blinked, then gasped. Color flooded back into her face. Clare almost wept with relief.“What was that?” she demanded.“I don’t know,” her friend answered slowly, still looking a little out of it. “I think it was a seizure.”Just over a decade earlier the young woman was diagnosed with epilepsy. But she’d had the strange episodes her doctors told her were seizures for many years. They were always the same: She would suddenly have a strong feeling of déjà vu, followed by a sense of impending doom and a sensation of falling, as if on an elevator dropping through space. Sometimes there was an odd chemical smell. She was awake throughout. She could hear everything and see everything, though sometimes she couldn’t speak. And then it would be over. The whole thing lasted less than a minute. The woman thought they were panic attacks, until she had one at work.She was teaching a swimming class when, in the middle of a sentence, she stopped speaking. She just stood there, not moving, for maybe 30 seconds. That was no panic attack, a fellow teacher stated flatly. She made an appointment to see her primary-care doctor in Vancouver, British Columbia, where she lived. He referred her to a neurologist. An EEG showed that the electrical activity was slower in her temporal lobe on the left. A scan of the brain was unrevealing, so she was started on an anti-seizure medication. And other than that, her life went on as before. She could play hockey, hike, climb and do the open-water swimming she loved.Every now and then, maybe two or three times a year, when she was very tired or stressed or she skipped a meal or two, she could still end up in that déjà vu, plunging-elevator moment. But she never lost consciousness — until two years earlier. She was with her mother when she suddenly stopped talking and slid off her chair. She woke almost immediately. Her mother took her to the emergency department at Vancouver General Hospital. The doctors there found nothing wrong. They weren’t sure what happened, but she seemed OK.She was sitting at her desk at work a few months later and the strange déjà vu and dread hit her. The next thing she knew, she was on the floor, her cheek throbbing from a rug burn. A few days later she got a call. The security camera had filmed something she needed to see. She sat in the security office and watched herself that day, sitting at her desk, then going completely limp and sliding out of her chair onto the floor. After about 15 seconds she saw her body jerk and then, again, nothing. Finally, after another 15 seconds or so, the body on the floor started to move. Slowly she sat up. Her movements were tentative, as if she were weak or drunk. Seeing this, the woman was scared. She called her neurologist. “Something bad happened,” she told the nurse. Her neurologist increased her anti-seizure medications and then referred her to the Epilepsy Clinic at Vancouver General Hospital.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

BBCAt a time when there are more than seven million patients on the NHS waiting list in England and around 100,000 staff vacancies, artificial intelligence could revolutionise the health service by improving patient care and freeing up staff time.

Tens of thousands of women who have gone through the menopause might benefit from a new bone-strengthening drug, says the medicines watchdog National Institute for Health and Care Excellence (NICE).

The herbicide, used widely on crops including broccoli and onions, can cause low birth weight and impaired brain development, regulators said.In a move not seen for almost 40 years, the Environmental Protection Agency on Tuesday issued an emergency order suspending all uses of a weedkiller linked to serious health risks for unborn babies.The herbicide dimethyl tetrachloroterephthalate, also known as DCPA or Dacthal, is used on crops such as broccoli, brussels sprouts, cabbage and onions. Babies whose pregnant mothers are exposed to it could suffer from low birth weight, impaired brain development, decreased I.Q., and impaired motor skills later in life, the E.P.A. said.“DCPA is so dangerous that it needs to be removed from the market immediately,” Michal Freedhoff, the E.P.A. assistant administrator for the Office of Chemical Safety, said in statement. “In this case, pregnant women who may never even know they were exposed could give birth to babies that experience irreversible lifelong health problems.”California-based AMVAC Chemical Corporation, the sole manufacturer of the pesticide, didn’t immediately respond to a request for comment.Tuesday’s order followed several years of “unprecedented efforts” by the Environmental Protection Agency to get AMVAC to submit its own data on the pesticide and its health risks, the agency said. The agency estimates that pregnant women handling DCPA products could be subjected to exposures four to 20 times greater than what E.P.A. has estimated is safe for unborn babies.Mily Treviño Sauceda, executive director of Alianza Nacional de Campesinas, also known as the National Farmworkers Women’s Alliance, called E.P.A.’s decision “historic.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A national survey found promising signs that key mental health measures for teens, especially girls, have improved since the depths of the pandemic.In 2021, a survey by the Centers for Disease Control and Prevention on teen mental health focused on a stark crisis: Nearly three in five teenage girls reported feeling persistent sadness, the highest rate in a decade.But the newest iteration of the survey, distributed in 2023 to more than 20,000 high school students across the country, suggests that some of the despair seen at the height of the pandemic may be lessening.Fifty-three percent of girls reported extreme depressive symptoms in 2023, down from 57 percent in 2021. For comparison, just 28 percent of teenage boys felt persistent sadness, about the same as in 2021.Suicide risk among girls stayed roughly the same as the last survey. But Black students, who reported troubling increases in suicide attempts in 2021, reported significantly fewer attempts in 2023.Still, the number of teens reporting persistent sadness in 2023 remained higher than at any point in the last decade aside from 2021. And around 65 percent of lesbian, gay, bisexual and transgender high school students reported persistent hopelessness, compared with 31 percent of their cisgender or heterosexual peers. One in five L.G.B.T.Q. students reported attempting suicide in the past year.“For young people, there is still a crisis in mental health,” said Kathleen Ethier, head of the C.D.C.’s adolescent and school health program. “But we’re also seeing some really important glimmers of hope.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Getty ImagesPeople can reverse their type 2 diabetes by going on a strict 900-calorie-a-day liquid diet offered by the NHS.

The estimate focused on five cancers for which there is medically recommended screening — breast, cervical, colorectal, lung and prostate — and found that colonoscopies accounted for most of the costs.The United States spent $43 billion annually on screening to prevent five cancers, according to one of the most comprehensive estimates of medically recommended cancer testing ever produced.The analysis, published on Monday in The Annals of Internal Medicine and based on data for the year 2021, shows that cancer screening makes up a substantial proportion of what is spent ever year on cancer in the United States, which most likely exceeds $250 billion. The researchers focused their estimate on breast, cervical, colorectal, lung and prostate cancers, and found that more than 88 percent of screening was paid for by private insurance and the rest mostly by government programs.Dr. Michael Halpern, the lead author of the estimate and a medical officer in the federally funded National Cancer Institute’s health care delivery research program, said his team was surprised by the high cost, and noted that it was likely to be an underestimate because of the limits of the analysis.For Karen E. Knudsen, the chief executive of the American Cancer Society, the value of screening for the cancers is clear. “We are talking about people’s lives,” she said. “Early detection allows a better chance of survival. Full stop. It’s the right thing to do for individuals.”“We screen for cancer because it works,” Dr. Knudsen added. “The cost is small compared to the cost of being diagnosed with late-stage disease.”Other researchers say the finding supports their contentions that screening is overused, adding that there is a weak link between early detection and cancer survival and that the money invested in cancer testing is not being well spent.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.