Nipple tenderness, also known as mastalgia, is a common physical complaint affecting people of all sexes and ages. This heightened sensitivity or soreness can range from a dull ache to a sharp, burning sensation. While the discomfort can be alarming, the causes are often related to normal physiological changes or minor external irritation. Most instances of tenderness are temporary and benign.
Hormonal Changes and Cyclical Tenderness
Fluctuations in reproductive hormones are the most frequent cause of nipple and breast tenderness. The delicate tissue within the breast is highly responsive to the cyclic changes in estrogen and progesterone. This sensitivity is a biological process preparing the mammary glands for potential pregnancy and lactation.
During the menstrual cycle, tenderness often peaks in the luteal phase, the time between ovulation and the start of a period. Estrogen stimulates the growth and density of the ductal system, while progesterone causes glandular tissue to swell and retain fluid, leading to a feeling of fullness and soreness. This cyclical pattern of tenderness is often predictable and subsides once menstruation begins.
Hormones also cause tenderness during other major life stages, such as puberty, early pregnancy, and perimenopause. The initial surge of estrogen during puberty drives the development of breast tissue, frequently causing sensitivity in the developing breasts. In early pregnancy, a dramatic, sustained rise in both estrogen and progesterone is often one of the first physical signs, causing significant tenderness as the ducts rapidly prepare for milk production.
Perimenopause, the transition leading up to menopause, involves erratic hormonal shifts that can lead to unexpected bouts of tenderness. As estrogen and progesterone levels fluctuate unpredictably, the breast tissue can respond with periods of swelling and pain. Hormonal medications, including some oral contraceptives, may also mimic these natural fluctuations, causing similar side effects of increased sensitivity.
External Factors and Physical Irritation
Beyond internal biology, the nipples are susceptible to physical irritation from the external environment. Repeated rubbing against clothing is a common culprit, especially during physical activity like running, a condition sometimes called “jogger’s nipple.” Friction from a poorly fitting bra or a rough fabric can chafe the delicate skin, leading to redness and soreness.
Contact with certain substances can also cause irritation of the sensitive nipple skin. Chemicals in new laundry detergents, soaps, body washes, or perfumes can trigger a localized reaction. Environmental factors, such as cold weather or dry air, can strip the skin of its natural moisture, leading to chapping or cracking and a painful, irritated sensation.
Nipple Pain Related to Infection and Skin Conditions
Sometimes, nipple tenderness is a symptom of an underlying medical or dermatological condition affecting the skin. Conditions like eczema and dermatitis cause inflammation, which can manifest as dry, scaly, itchy, or burning patches on the nipple and areola. This is often a form of contact dermatitis, an inflammatory reaction to an irritant or allergen touching the skin.
Localized infections can also cause significant pain and tenderness. In those who are lactating, mastitis is an inflammatory condition that occurs when bacteria enter the breast tissue, typically through a crack in the nipple. Mastitis is often accompanied by systemic symptoms like fever, chills, and a breast that is noticeably red, hot, and swollen. Another common infection, candidiasis (thrush), is a fungal issue that causes a burning, stinging, or shooting pain that may radiate through the breast.
When Tenderness Signals a Larger Concern
While most instances of nipple tenderness are benign, certain associated symptoms warrant immediate medical evaluation. Pain that is severe, persistent, and not clearly linked to the menstrual cycle should be investigated. Tenderness confined to only one breast (unilateral) suggests a cause other than systemic hormonal fluctuation.
Spontaneous nipple discharge that occurs without manual manipulation is a red flag, particularly if the discharge is clear, bloody, or serosanguineous (pink or blood-tinged). A change in the skin’s appearance should also prompt a consultation, including:
Concerning Physical Changes
- New lumps or thickening.
- Skin texture changes like dimpling or puckering.
- The nipple pulling inward (inversion).
- An unexplained rash or scaling that does not resolve quickly.