hurts – USMAIL24.COM https://usmail24.com News Portal from USA Fri, 16 Feb 2024 23:07:29 +0000 en-US hourly 1 https://wordpress.org/?v=6.4.4 https://usmail24.com/wp-content/uploads/2024/01/Untitled-design-1-100x100.png hurts – USMAIL24.COM https://usmail24.com 32 32 195427244 Trump hit where it hurts most https://usmail24.com/trump-trial-fraud-ruling-html/ https://usmail24.com/trump-trial-fraud-ruling-html/#respond Fri, 16 Feb 2024 23:07:29 +0000 https://usmail24.com/trump-trial-fraud-ruling-html/

This one is going to sting Donald Trump took a huge hit today in the two places that hurt him most: his wallet and his image as a business wizard. The blows were dealt by a state judge in New York, who sentenced Trump to pay fines of almost $355 million for years of fraud […]

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Donald Trump took a huge hit today in the two places that hurt him most: his wallet and his image as a business wizard.

The blows were dealt by a state judge in New York, who sentenced Trump to pay fines of almost $355 million for years of fraud by lying about the value of his real estate portfolio. As part of his decision, the judge, Arthur Engoron, also banned Trump from running any New York company — including his own company, the Trump Organization — for three years.

The company has been at the center of Trump's public persona as a wealthy businessman for decades. And in the smallest detail, Judge Engoron has not definitively taken away control of the case. Still, the ruling – if it stands up on appeal – will have significant consequences for the former president's assets.

Whatever financial pain Trump now faces was matched by the damage the decision did to his ego and to his image as a jet-setting billionaire and chief executive, a carefully crafted public face that helped him become the first reality TV star. to become stardom. and then to the White House.

“Their complete lack of remorse and remorse borders on the pathological,” Judge Engoron wrote of Trump and his co-defendants in the case, including his two adult sons, Eric and Don Jr.

The judge also said that the charge of “inflating the value of assets to make money” was “not a mortal sin” and that Trump, his sons and two of his top associates at the company “did not rob a bank at gunpoint.” And yet, Judge Engoron concluded, “defendants are unable to admit their error. Instead, they adopt a 'See no evil, hear no evil, speak no evil' attitude that is belied by the evidence.”

Trump was already hit with a separate decision last month in which a federal jury in New York ordered him to pay writer E. Jean Carroll more than $83 million for defaming her in 2019 after she accused him of a decades-long rape. And the massive fraud penalties he faces, combined with the restrictions placed on his ability to run businesses in New York and borrow money from financial institutions in the state, could leave him in financial trouble.

It was not immediately clear how quickly Trump and the others, who faced smaller verdicts, will have to come up with the money. The ruling's provision banning Trump from applying for loans in New York in the next three years could make it challenging to obtain the bond he must submit to the court if he appeals the decision.

Trump's lawyer, Alina Habba, described the ruling as a “manifest injustice – plain and simple. It's the culmination of a multi-year, politically fueled witch hunt designed to “take down Donald Trump” before Letitia James ever entered the attorney general's office. Countless hours of testimony have proven that there was no wrongdoing, no crime and no victim.”

Judge Engoron's decision capped a busy week that saw major developments in several criminal cases facing Trump. Some cut corners in his favor, others didn't.

Perhaps the most important step: A state judge in Manhattan set March 25 as the date for Trump's first criminal trial — on charges of falsifying company records about hush money payments to a porn star in the run-up to the 2016 election.

Of all the cases Trump faces as he wages his campaign to retake the White House, the hush-money case is the one that some of his advisers see as the most politically advantageous to him. They believe this could desensitize voters to the other cases Trump is facing, in which he faces more serious charges stemming from his mishandling of classified materials and from his efforts to prevent the peaceful transfer of presidential power after the election of 2020 to disrupt.

The hush money case relies heavily on testimony from Michael Cohen, Trump's former lawyer and fixer, who has already pleaded guilty to making the payment, as well as lying to Congress and tax-related charges. Cohen was also a key witness in the civil fraud case in Judge Engoron's courtroom. But while Trump's advisers were pleased with their controversial cross-examination of Cohen during the fraud trial, Judge Engoron considered him a “credible” witness.

“This fact finder does not believe that pleading guilty to perjury means never being able to tell the truth,” Judge Engoron wrote. “Michael Cohen told the truth.”

For more: Read the judge's ruling in the civil fraud case.


Trump is at the center of at least four separate criminal investigations, at both the state and federal level, into matters related to his business and political careers. Here's where each case currently stands.

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I have bigger boobs and it hurts so much – most tops only look good on women with fake perky boobs https://usmail24.com/beauty-queen-tops-look-good-fake-boobs-htmlns_mchannelrssns_campaign1490ito1490/ https://usmail24.com/beauty-queen-tops-look-good-fake-boobs-htmlns_mchannelrssns_campaign1490ito1490/#respond Wed, 10 Jan 2024 20:36:28 +0000 https://usmail24.com/beauty-queen-tops-look-good-fake-boobs-htmlns_mchannelrssns_campaign1490ito1490/

Sydney Hella from Colorado criticized the fashion industry for its lack of options The 24-Year-Old Who Says 99% of Tops Aren’t Made to Support ‘Normal Breast Tissue’ By Shannon McGuigan Published: 07:19 EST, January 10, 2024 | Updated: 07:26 EST, January 10, 2024 A beauty queen has lamented the lack of clothing options for women […]

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  • Sydney Hella from Colorado criticized the fashion industry for its lack of options
  • The 24-Year-Old Who Says 99% of Tops Aren’t Made to Support ‘Normal Breast Tissue’

A beauty queen has lamented the lack of clothing options for women with naturally larger breasts, claiming shirts with plunging necklines are usually designed for those with breast implants.

Sydney Hella, 24, from Denver, Colorado, who is competing in the Miss Earth competition, took to TikTok to criticize the fashion industry for not offering enough options for people with “natural breast tissue.”

She confessed that she struggles to find fashionable and comfortable options that suit her because gravity ultimately “does its thing.”

In a clamp who has now amassed more than half a million likes, Sydney remained realistic about her fashion woes, joking that having a bigger chest is “such a pain.”

Sydney Hella (pictured) from Denver, Colorado has criticized the fashion industry for its lack of supportive tops for those with ‘naturally’ large breasts

According to Sydney, the type of top that looks good on everyone is “rare” and “few in between.”

But the beauty queen pointed out that the main problem with tops designed for women with good physiques is that they are made for women with fake ‘perky’ breasts.

“The tops that look best 99% of the time are in no way designed to support any normal breast tissue,” she said.

‘If you naturally have larger breast tissue, gravity will do its work.’

She continued, “This is absolutely not hatred towards people who choose to get breast implants. You do what you want with your body.

But I just think there’s definitely some “these tops look good with a bigger bust” thing. No, these tops look good with fake breasts that fit perfectly without any form of support.’

The Miss Colorado beauty queen confessed that she often struggles to find stylish and comfortable tops because gravity eventually

The Miss Colorado beauty queen confessed that she often struggles to find stylish and comfortable tops because gravity eventually “does its thing.” She highlighted that tops designed for women with good physiques are often made for false ‘perky’ breasts

To further express her frustrations, Sydney was adamant that options for women with larger breasts who “probably sag a little and need support” are extremely limited.

In the caption, she clarified that she was aware of such brands making their way to the market, but that they are “expensive” and a “frustrating[ly]’ long time.

Many flocked to the comments to share their own experiences, praising the beauty queen for not telling “a single lie.”

‘THANK UUUUU I have naturally large breasts that are not perky and I have to wear a bra at all times. It’s so annoying that I can’t find a top that hides the bra,” one person wrote.

A second commented: ‘This is what makes shopping for clothes, especially dresses, such an exhausting experience. nothing ever fits right.”

Many users flooded the comments, expressing their frustrations and sharing their own experiences and difficulties finding suitable tops

Many users flooded the comments, expressing their frustrations and sharing their own experiences and difficulties finding suitable tops

‘ALSO!!! Sometimes I want to look cute without everything looking inappropriate and like I’m going out,” one user shared

“32DDD and I see too many tops and say, ‘I know that just doesn’t look right.'”

Another said: ‘I love the bralette trend too, but I definitely can’t walk around without that support.’

A viewer asked: ‘No, but the fact that all the trendy clothes right now are for people with small breasts is really sad because what are we going to wear?

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Dunking hurts: Why players hate — and love — the NBA’s greatest feat https://usmail24.com/nba-dunks-players-history-injury-anthony-edwards/ https://usmail24.com/nba-dunks-players-history-injury-anthony-edwards/#respond Fri, 22 Dec 2023 22:46:10 +0000 https://usmail24.com/nba-dunks-players-history-injury-anthony-edwards/

The dunk is basketball’s most lionized play. The most iconic ones are canonized, referenced fondly and often, debated for their merits and significance. The sport’s language has created so many names for it: jam, yam, slam, poster, stuff, hammer. It’s a unique club that only few on this world can join. It’s marvelous. And it […]

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The dunk is basketball’s most lionized play. The most iconic ones are canonized, referenced fondly and often, debated for their merits and significance. The sport’s language has created so many names for it: jam, yam, slam, poster, stuff, hammer. It’s a unique club that only few on this world can join. It’s marvelous.

And it hurts like hell.

“Can you think of any other concept where your hand swings at something metal?” 11-year NBA veteran Austin Rivers asks. “It’ll probably hurt, yeah?”

When asked, players catalog the pain dunking has caused: broken nails; bent fingers; recent bruises; lasting scars; midair collisions; twisted necks; dangerous landings. Injuries that cost them games or even seasons.

Derrick Jones Jr., a former NBA All-Star Weekend dunk contest winner now with the Dallas Mavericks, points out two specific marks on his left wrist. Larry Nance Jr., another high flier in his ninth NBA season and third with the New Orleans Pelicans, recalls childhood memories of his father’s scarred arms from a 14-year NBA career that included winning the first-ever dunk contest in 1984. Dallas’ Josh Green remembers one pregame dunk that set his nerves afire.

“I remember thinking, ‘Why would I do this before a game,’” the 23-year-old Green says.

And yet still they dunk.

In the modern NBA, the dunk’s frequency has been increasing, going from 8,254 in the 2002-03 regular season to 11,664 last year. The rise is mostly due to the 3-point revolution and the increased spacing and cleaner driving lanes that come with it. But the league also has taller, more explosive athletes entering every year. With them come even more spectacular aerial feats, ones that enrapture fans and wow even the players who witness them.

What players think of the dunk, and the agony that can come with it, is ever changing. This isn’t some new trend. It’s just that the dunk, for all its allure and mystique, is the most visceral mark of a player’s maturation.

Basketball’s most exclusive club, one only entered 10 feet in the air, isn’t one that players can — or always want to — live in forever.


Dennis Smith Jr., now a member of the Brooklyn Nets, had a 48-inch vertical as a prospect, but says now his struggles with landing affected his shooting form. (Nathaniel S. Butler / NBAE via Getty Images)

When young basketball players first start dunking, they never want to stop.

“It makes you the guy,” Dennis Smith Jr. says.

Smith’s first in-game dunk was an off-the-backboard slam in a state title game when he was 13. His team was up big and his teammates were showing off. “Now it’s my turn,” the 26-year-old Brooklyn Nets guard recalls thinking. “I got one.” An in-game dunk is a status symbol he has never forgotten.

Willie Green, now the head coach of the New Orleans Pelicans after a 12-year NBA career, was told as a teenager that toe raises would help him reach above the rim. Every morning in the shower, he counted to 300 — rising onto the balls of his feet with each number until this club finally let him in.

“If you could dunk, people looked up to you, they glorified you,” Green says. “You felt like you got over a big hurdle in basketball. It was a huge step in basketball when I was able to dunk.”

Every player asked remembers how old they were when they first started. “You’re young, you’re bouncy,” Markieff Morris, 34, says. “You dunked so you could talk your s—.” It was the first thing youngsters like him did stepping into the gym, the last before they left.

“When you’re first dunking, your fingers are full of blood because of the (contact),” Philadelphia 76ers forward Nicolas Batum recalls. “But you get used to it. You have so much joy of dunking. You’re one of the few people in the world that can.”

Once players start dunking in games, it becomes even more addicting. “When you try to dunk on someone, you’re hyped up, you’re amped up,” the New York Knicks’ Donte DiVincenzo says. “You don’t feel any of that s—.” It’s the same as any adrenaline high. “It feels like energy,” 21-year-old Mavericks guard Jaden Hardy says. As the crowds grow bigger and the reactions reverberate louder, it’s even better.

Marques Johnson, a five-time NBA All-Star who retired in 1990, remembers one slam he had at age 15 in a summer league over a player who had just been drafted to the NBA. To dunk on him, to knock him to the ground, proved something.

“As a young player, if you can hang with guys on the next level,” he says, “it becomes that validation that you belong.”

Johnson, currently the Milwaukee Bucks’ television analyst, played collegiately for UCLA, where he was named the Naismith College Player of the Year in 1977, the first season the dunk was re-legalized in college basketball. “I really believe it’s a big reason why I won,” he says. “People ain’t seen a dunk in college basketball in 10 years.” Johnson, a hyperathletic 6-foot-7 forward, took up residence above the rim.

Once, he missed two weeks with a knee sprain after dunking on a teammate in practice and landing hard. As he lay on the ground in pain, he still remembers what his first question was.

“Did the dunk go in?”

“Yeah,” he was told. “You dunked on him.”


Marques Johnson, shown here with the Bucks, believes dunking was a big reason he was the Naismith Player of the Year in 1977. (Heinz Kluetmeier / Sports Illustrated via Getty Images)

Last season, Christian Wood rebounded his own miss and found an empty path to the rim. He dribbled once, planted both feet, hurled the ball through the rim — and then clutched his left hand as he ran back down the court.

Wood, who signed with the Los Angeles Lakers this summer after his one season with the Mavericks, finished the game but missed the next eight with a broken thumb. “I went for a tomahawk (dunk), trying to look flashy for some reason, and hit my thumb again,” he says. He had already injured it, he says, but that’s the moment when he knew he “had really hurt it.”

As teenagers age into veterans, their relationships toward dunking often change. “To really dunk consistently in the NBA, you gotta be a freak athlete.” Rivers says. For those who aren’t, dunking becomes more akin to a tool than a feat.

“S—, those things are really adding up,” the 26-year-old DiVincenzo says. “A lot of the younger guys want to dunk every single time. I am not like that anymore.”

DiVincenzo still dunks — he had nine last year with the Golden State Warriors — but prefers layups when possible. It isn’t always possible, though. “Sometimes, (a dunk) is the only way to draw fouls,” he says.

When Willie Green neared the end of his career, he recalls hating when defenders forced him into it.

“They’re chasing you down hard on a fast break, and you want to lay it up, but you know if you lay it up, they’re going to block it,” he says. “I’m like, ‘Man. You made me dunk that.’”

Green was a two-foot dunker, which meant accelerating into the air was hard on his knees, especially the left one, which was surgically repaired in 2005. “That force, that gravity, compounded with coming down,” he says. “It takes a toll on you.”

Smith, the ninth pick in the 2017 draft, entered the league with a record-tying 48-inch vertical — and with a dangerous habit of coming down on one leg. While recovering from knee surgery, he learned to land on both of them. “I don’t even think about it now,” he says. But he still does thoracic therapy to treat scar tissues in his wrist from his childhood dunks, which he believes has had an effect on his shooting form.

The league’s freak athletes, the ones Rivers referenced, do have different experiences. Nance Jr., who remembers his father’s forearm scars, has none of his own. His hands are large enough to engulf the ball rather than pinning it against his wrist. “I never really learned how to cup it like everybody else,” Nance says. “I genuinely don’t believe I could do it if I tried.” He drops the ball through the rim rather than relying on inertia.

“Not really,” he says when asked whether it hurts. “Unless I miss.”

Players like him still experience pain from the midair collisions and the misses: when the basketball hits the cylinder’s rear and sends shock waves through their arms; when an opponent’s desperate swipes hit flesh and nerve; when the crash of bodies sends theirs sprawling to the floor.

Anthony Edwards, another alien athlete, doesn’t even refer to what he does as dunking. “I don’t really dunk the ball,” he says. “I just put it in there the majority of the time.” Earlier this month, though, Edwards elevated over the Oklahoma City Thunder’s Jaylin Williams, nicked him on the shoulder and came crashing back down.

Though Edwards only missed two games with a hip injury, the Timberwolves’ rising star admitted he was “scared” and “nervous” in his first game upon returning. And even if missed dunks don’t injure him, there’s still pride.

As Edwards said of them last season: “Those hurt my soul.”


Anthony Edwards, shown here after a dunk in last season’s Play-In Tournament, was recently injured on a dunk attempt against Oklahoma City. (Adam Pantozzi / NBAE via Getty Images)

Kyrie Irving had stolen the ball and was alone at the basket in a December game when he rose up to dunk in front of his own bench. His Dallas teammates had already risen up to celebrate — until they couldn’t.

“I mistimed it,” he says. “My momentum wasn’t there.” The ball grazed the front of the rim and fell out.

The 31-year-old Irving is known for every sort of highlight except dunking, of which he has only 25 in his 11-year career. But a flubbed dunk is embarrassing even for a player like him.

“You just feel bad!” he says. “We’re the best athletes in the world. I should be able to get up there once in a while.”

Later that quarter, the 6-foot-2 Irving had another chance at a wide-open fast break, at redemption. This time, he made sure to prove he could still do it.

“I had to double pump,” he says, laughing now. “I had to get up there, bro. I couldn’t come in the locker room to my teammates, coaching staff, upper management. They would’ve been on my head.”

Still, as players grow closer to retirement, they often hang up their dunking careers first.

Rivers, who remains a free agent after spending his 11th season with the Minnesota Timberwolves in 2022-23, recently retired from dunking. “I just prefer laying the ball up,” he said last year. “A dunk takes a lot out of me.” It was the hard landings that ultimately got him to stop, but he believes he became a better finisher once he made the decision.

It’s easier for veterans who never needed to play above the rim. Like, say, Stephen Curry, who seems amused he was asked about something he hasn’t done in a game since 2018.

“I had no problem letting that part of myself go,” the 6-foot-3 Curry says. “I very easily moved on to the next chapter of my career.”

Batum, a 35-year-old with 367 career dunks, also swore off contested dunks before last season. “My body told me,” he said. “It said, ‘No more, bro.’” Now he only dunks, gently with two hands, when he knows he’s alone at the rim.

“When you hit 32, the game isn’t about dunking anymore,” says Morris, now in his 13th NBA season. “It’s about longevity and still being able to play at a high level.”

Caron Butler wishes he had realized that sooner. When he was younger, Butler, who had two All-Star appearances before retiring to become a Miami Heat assistant coach, practiced as hard as he played.

“I overemphasized the two points I was getting to prove a point or show off my God-given ability,” he says. “It would have given me more longevity.”

Butler doesn’t have any regrets. But he thinks about the dunk differently now.

“It’s just two points.”


Caron Butler, shown here leaping between two Cavaliers during the 2008 NBA playoffs, said his attitude toward dunking changed as he got older. “It’s just two points,” he says. (Ned Dishman / NBAE via Getty Images)

It’s just two points.

“I’m listening to an old man talk,” Butler says. “That’s what 13-year-old Caron Butler would say. He would say, ‘I’m listening to a very old man talk about dunking.’”

He’s not the only retired player who sees the irony. Green thinks his younger self, the one who counted his toe raises in the shower, would feel similarly

“Thirteen-year-old me would really be disgusted right now,” he says.

But Green did dunk again earlier in 2023, a windmill slam in a January practice that had his players hollering in amazement. “They always tell me I can’t dunk,” he says. “I wanted to show them I had a little juice.” Green, the league’s fifth-youngest head coach, says that one of his coaching qualities is his relatability.

“When you’re asking high level professional athletes to do something, it helps for them to know that you’ve done it,” he says. “And it helps to know when they look at you that it looks like you still can do it.”

For others, it’s something that hearkens back to the past: to the adrenaline rush they first felt, to the validation it gave when their NBA careers were still dreams. Klay Thompson, perhaps this sport’s second-best shooter ever behind Curry, his Warriors teammate, says one of the best moments of his career was a dunk. After missing two consecutive seasons with major surgeries, in his first game back, he drove to the rim and slammed one. Thompson knew in that moment, he says, that the Warriors could still win another championship — and later that season, they did.


The end result of Klay Thompson’s dunk through multiple Cavaliers in his first game back from ACL and Achilles injuries. (Jed Jacobsohn / Getty Images)

Thompson used to stroll onto the court and dunk as soon as his shoes were on. “Now, I need a good hour to get the gears greased and the motor working,” he says. As his body has changed, so too has his appreciation for what dunking means.

“It’s always an amazing feeling hanging on the rim that you can (forget) most people can’t do it,” he says. “I no longer take it for granted.”

It’s just two points for these club members, yes, but it’s more than that. For Johnson, the former Naismith College Player of the Year, dunking still means something special. Johnson turns 68 in February, and he plans to continue his personal tradition that began when he was 55: dunking on his birthday.

It’s motivation, Johnson explains, to stay in shape, which was inspired by his son, Josiah, who films it every year. It started becoming harder when Marques turned 60. “The first two attempts, I’m barely getting above the rim,” he says. It’s harder to palm the ball as his hands lose strength, and it usually takes until the fifth or sixth try before he succeeds.

Johnson, who had hip surgery this summer, doesn’t know if he will succeed next year. After all, he only attempts to dunk on his birthday, never in-between. “I know, eventually, I’m not going to be able to do it,” he says. But his recovery has gone well, and he feels good he’ll dunk once more next February.

He still remembers it, misses it.

“I remember them vividly: the excitement, the adrenaline rushing through your body,” he says. “So the dunk, as you can tell, has meant a whole lot to me.”

When asked what his younger self would think about hearing him talk about dunking now — this exclusive club he first joined as a 14-year-old wearing slacks and dress shoes, one that has represented pain and joy, aging and authenticity — Johnson instead chooses to turn the question around.

“I’d tell 16-year old me,” he says, “do it until the wheels come off.”

(Illustration by Rachel Orr / The Athletic. Photos of Derrick Jones Jr. (left) and Anthony Edwards (right): Amanda Loman and David Berding / Getty Images)

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Getting an IUD hurts. Why don’t more women get help? https://usmail24.com/iud-insertion-pain-relief-html/ https://usmail24.com/iud-insertion-pain-relief-html/#respond Thu, 14 Dec 2023 16:26:35 +0000 https://usmail24.com/iud-insertion-pain-relief-html/

According to data from the Centers for Disease Control and Prevention, women are increasingly turning to the intrauterine device, or intrauterine device, as a form of birth control. published today. Yet it is common knowledge that IUD insertion can be excruciatingly painful, and few doctors provide effective relief. Anticipating the pain is “a potential barrier” […]

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According to data from the Centers for Disease Control and Prevention, women are increasingly turning to the intrauterine device, or intrauterine device, as a form of birth control. published today. Yet it is common knowledge that IUD insertion can be excruciatingly painful, and few doctors provide effective relief. Anticipating the pain is “a potential barrier” to expanding access, said Dr. Lauren Zapata, an epidemiologist in the Division of Reproductive Health at the CDC

About 20 percent of women relied on an IUD between 2015 and 2019, a dramatic increase from the 8 percent who used one between 2006 and 2010. But social media platforms are flooded with women who feel sorry their painful IUD insertionsand sometimes relocations. A study published this year who scanned TikTok for the top 100 videos with the hashtag #IUD found that of the videos that presented a patient’s experience, almost all – 97 percent – ​​highlighted the pain of the procedure and other negative side effects.

“In general, I always recommend an IUD,” says Dr. Jenny Wu, author of the TikTok study and third-year obstetrics and gynecology resident at Duke. “But then I also noticed that many of my younger patients, Gen Z, just don’t want an IUD.” Also a separate report from the CDC published todayfound that only 6 percent of teens have used an IUD, making it one of the least common methods for that age group.

There are a handful of effective options for pain management during IUD insertion. Yet doctors have rarely discussed or used them, says Dr. Eve Espey, chair of the University of New Mexico’s department of obstetrics and gynecology. a research published this year found that only 4 percent of trained physicians in the United States offered an injection of a local anesthetic, which was found to be effective for pain relief. And nearly 80 percent of trained physicians, the survey found, offered over-the-counter painkillers such as ibuprofen, which have been shown to be less effective.

That may be because historically there has been little data to support the use of some pain management methods, such as a local anesthetic, said Dr. Espey. And 10 to 15 years ago, so were a majority of IUD users women who had given birth – and there is evidence that they experience less pain during insertion, she added.

It also comes down to minimizing pain in women, said Dr. Andrew Goldstein, a gynecologist and pelvic pain specialist. “I do believe gaslighting is a common phenomenon,” he said. “Women’s pain must be believed and alleviated.”

As new research confirms the effectiveness of some methods, and informed patients advocate for themselves, some doctors are beginning to offer multiple pain relief options for IUD insertion and even removal—a shift in practice that has begun to occur over the past three years. strengthen. or something,” said Dr. Wu.

The CDC, whose current guidelines vaguely support the use of a local anesthetic, is reviewing recently published data on pain management from IUD insertions with plans to update the recommendations next year.

In order to get the T-shaped device into the uterus, it must first make its way through the cervix. “Any manipulation of the cervix can be quite uncomfortable,” said Dr. Goldstein, because it has several nerves that signal pain. The internal canal of the cervix is ​​also “physiologically closed,” Dr. Espey said, and “you have to push quite hard” or even use a dilator to get the IUD in. Women who have given birth are more likely to have a mild and more open cervix, she said, and therefore the insertion could be less painful for them.

The procedure takes three to four minutes.

Doctors can provide targeted pain management options that focus on the cervix, or more general pain relief. “Pain perception, however, is very idiosyncratic,” said Dr. Goldstein, and what works for one woman to reduce pain may not be enough for another.

With this option, lidocaine is injected into two different spots near the cervix to numb the area. In 2016, the CDC discovered only limited evidence that this method could reduce the pain of the IUD. But more recent research, including studies published in 2017 And 2019suggests that it is effective during and after the procedure, and more doctors are now beginning to use it more routinely, said Dr. Goldstein. The paracervical block is usually also covered by insurance.

But not every clinic is set up to offer the method, and it can also double the time of the insertion procedure, said Dr. Espey. And when you describe what it takes to get a paracervical block, “people don’t like the idea,” she added, “because it’s another needle.”

Doctors may also offer a topical lidocaine gel or spray, but the evidence on its effectiveness is mixed, Dr. Goldstein said. Some research suggests that it can reduce the pain of gripping the cervix during the procedure, but it is “nowhere near the amount of pain relief that the paracervical block provides,” he said.

A wide variety of drugs, including not only Tylenol and ibuprofen, but also strong opioids, such as Oxycodone, fall into this category. Although a majority of doctors suggest an over-the-counter drug, “we now have enough studies to know that it doesn’t work,” said Dr. Espey. There is limited evidence for opioids, although they generally appear to be more effective than over-the-counter medications at reducing pain, she added.

But keep in mind that it may take an hour for all these options to take effect. So if you walk into a clinic and want an IUD inserted the same day, the drug will add time to the procedure.

It was long thought that the drug used in medical abortions was misoprostol, could ease the pain of IUD insertions because it softens the cervix, said Dr. Espey. But research doesn’t support that theory, and while the CDC advises against this In most cases, about 15 percent of trained physicians still use it on women who have never given birth before. If a doctor suggests it, you should push for more options, Dr. Goldstein said.

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