Nipple pain, also known as mammillary pain, is a common experience that can affect people of any sex and at any stage of life. The sensitivity of the area makes it susceptible to discomfort from a wide range of factors, from mechanical irritation to internal hormonal shifts. While nipple pain is frequently benign and temporary, understanding its specific cause is the necessary first step toward finding relief and ensuring overall health.
Pain Related to Latch and Breastfeeding Mechanics
The mechanical process of milk removal is the most frequent cause of nipple pain for nursing parents. The primary issue is often a shallow or incorrect latch, where the infant does not take enough breast tissue into their mouth, causing the nipple to be compressed against the hard palate or gums. This compression results in trauma, which can lead to soreness, cracking, or blistering of the nipple surface. A proper latch requires the infant to cover not just the nipple but a significant portion of the areola, ensuring the nipple rests comfortably far back in the baby’s mouth.
Incorrect positioning of the infant during a feed can also contribute to trauma, preventing the deep latch needed for comfortable and effective milk transfer. Furthermore, structural issues in the infant’s mouth, such as a tongue tie (ankyloglossia), can severely restrict the tongue’s movement, making it difficult to form a seal and draw milk effectively. When the infant cannot use their tongue properly, they may resort to chewing or clamping the nipple, leading to significant pain and damage.
Beyond the direct trauma of an improper latch, temporary conditions related to milk supply can cause pain. Breast engorgement, where the breasts become overly full, hard, and tight, can flatten the nipple, making it difficult for the baby to latch correctly and causing discomfort. Blocked milk ducts, which feel like a painful, tender lump or a localized wedge of hardness in the breast, also contribute to pain and inflammation, though they are distinct from an infection. Even using a breast pump with an incorrectly sized flange or excessive suction can exert damaging pressure on the nipple and areola tissue.
Infectious, Inflammatory, and Dermatological Causes
Pain that is persistent, burning, or intensely itchy often suggests a cause rooted in infection or a chronic skin condition. Nipple thrush, a fungal infection caused by an overgrowth of Candida albicans, is common in breastfeeding individuals and is characterized by a deep, stabbing, or burning pain that may continue after a feeding. The nipple may appear bright pink or red, and the areola can look flaky or dry, often requiring simultaneous treatment for both the parent and the infant.
Bacterial infections, most notably mastitis, typically present with a rapid onset of pain, swelling, and redness in the breast, often accompanied by systemic flu-like symptoms and fever. This infection usually occurs when bacteria enter the breast tissue through a crack or break in the nipple skin, often a result of untreated breastfeeding trauma. Non-infectious inflammatory conditions, like eczema (atopic dermatitis) or psoriasis, can also affect the nipple and areola, causing chronic itching, scaling, and inflammation.
Contact dermatitis, an inflammatory skin reaction, results from direct exposure to an irritant or allergen, causing itching, stinging, and a rash. Common culprits include new laundry detergents, fabric softeners, soaps, lotions, or certain topical creams applied to the area. Distinguishing contact dermatitis from chronic conditions like eczema is important, as the former is a direct reaction to a substance that must be removed.
Hormonal Fluctuations and Internal Changes
Internal shifts in hormone levels are a frequent, non-mechanical cause of nipple and breast sensitivity. Cyclical mastalgia, or breast pain related to the menstrual cycle, is the most common form of discomfort, typically peaking in the week leading up to a period. The temporary rise in estrogen and progesterone during this time causes the breast ducts and milk glands to swell, leading to a feeling of tenderness, fullness, and soreness. This pain usually resolves once menstruation begins.
Pregnancy causes a rapid and significant increase in hormones, and nipple tenderness is one of the earliest signs, often occurring within the first trimester. The heightened levels of estrogen and progesterone prepare the breasts for lactation, resulting in sensitivity, swelling, and sometimes a tingling sensation. Similarly, hormonal medications, such as combined oral contraceptive pills or hormone replacement therapy, introduce synthetic hormones that can mimic these natural changes, sometimes causing or worsening breast and nipple tenderness as a temporary side effect.
Friction, Trauma, and Environmental Irritants
External forces unrelated to internal physiology or pathogens can directly damage the sensitive nipple tissue. Repetitive friction from clothing is a common culprit, particularly during exercise, leading to a condition often called “runner’s nipple” or “jogger’s nipple”. This occurs when a shirt or bra rubs against the nipple over a prolonged period, causing chafing, dryness, raw skin, and sometimes bleeding. Wearing ill-fitting clothing or materials like rough cotton, especially when wet with sweat, significantly increases the risk of this type of trauma.
Acute physical trauma from an impact or injury can also result in localized pain and tenderness that lingers for days or weeks. Nipple piercings create a wound that requires a long healing period and is susceptible to irritation from clothing, snagging, or the jewelry itself. Environmental factors can also contribute to pain, such as extreme dryness or exposure to cold temperatures, which can lead to chapping or cracking of the skin.
When Nipple Pain Signals a Serious Issue
While most nipple pain is benign, certain accompanying symptoms warrant immediate medical evaluation to rule out a more serious underlying condition. Pain that is chronic, severe, or does not improve with simple home care should be investigated by a healthcare professional. A serious warning sign is any new, firm lump or mass felt in the breast or under the armpit.
Changes in nipple and skin appearance are also significant indicators. These include a nipple that suddenly begins to pull inward (inversion), or skin that becomes thickened, scaly, dimpled, or resembles an orange peel. Any discharge that is not breast milk, particularly if it is bloody, clear, or occurs spontaneously from only one duct, must be checked by a doctor.
Nipple pain accompanied by systemic illness, such as a high fever, severe chills, or a general feeling of being unwell, requires prompt attention. These symptoms may signal a rapidly progressing infection or an inflammatory type of cancer.