Nipple pain stems from dozens of possible causes, but the vast majority are benign and temporary. Friction from clothing, hormonal shifts tied to the menstrual cycle, breastfeeding difficulties, and skin irritation account for the bulk of cases. Still, the sheer variety of triggers means that what feels like the same symptom can point to very different underlying issues, and a few of those warrant prompt attention from a doctor.
Friction and Chafing
One of the simplest and most overlooked causes of nipple pain is plain mechanical friction. Repetitive rubbing from a shirt, sports bra, or poorly fitted undergarment can irritate the delicate skin of the nipple, producing soreness, redness, and sometimes cracking or light bleeding. Runners know this well as “jogger’s nipple,” a condition that becomes more likely as weekly mileage climbs. Research on distance runners found that athletes who logged longer weekly distances had significantly higher rates of nipple chafing, largely because of extended contact with synthetic or coarse-fiber fabrics like nylon jerseys.1Anais Brasileiros de Dermatologia. Sports-related dermatoses among road runners in Southern Brazil
This problem is not limited to endurance athletes. Anyone who works out in a loose cotton shirt, goes braless under a rough fabric, or wears a bra that does not fit snugly can experience the same thing. The fix is usually straightforward: moisture-wicking, close-fitting tops; adhesive nipple covers or anti-chafing balm; and prompt treatment of any broken skin to prevent infection. If chafing has already happened, keeping the area clean and dry and applying a thin layer of petroleum jelly while the skin heals tends to resolve things within a few days.
Hormonal Shifts Across Life Stages
Hormones are behind a huge share of nipple and breast tenderness, and the timing of the discomfort often tells you which hormonal shift is responsible. In menstruating adults, the most common pattern is cyclical mastalgia, where rising progesterone in the second half of the cycle causes the breast tissue to retain fluid and swell. Nipples can feel tender, sore, or hypersensitive for a few days before a period, then the discomfort fades once bleeding starts. This pattern is so predictable that tracking when the pain shows up relative to your period is one of the most useful diagnostic clues.
Puberty brings its own version. Both girls and boys experience breast bud development early in puberty, and that tissue is exquisitely tender as it grows. In teenage boys, pubertal gynecomastia, the temporary enlargement of breast tissue, affects up to half of adolescents in the relevant age range and has been growing more common in recent years.2PubMed Central. Endocrine Hormones and Their Impact on Pubertal Gynecomastia The swelling usually sits directly behind the nipple, making the nipple itself the focal point of discomfort. Breast soreness in teenagers of any sex is overwhelmingly benign and typically resolves on its own within a year or two, though knowing that does not make it less uncomfortable or less anxiety-provoking.3Best Practice & Research Clinical Obstetrics & Gynaecology. Breast problems and diseases in puberty
At the other end of reproductive life, the hormonal swings of perimenopause can also trigger breast and nipple pain. Estrogen levels fluctuate unpredictably, sometimes spiking higher than they did during regular cycling years, and that volatility can make the breasts sore in ways that feel unfamiliar. Hormone replacement therapy can compound this. A study of postmenopausal women starting HRT found that the treatment caused a transient increase in breast tenderness, particularly in women who were further from menopause and had not experienced much tenderness before starting treatment. Both oral and transdermal formulations triggered the effect, though it tended to settle down after the first several weeks.4PubMed. Paradoxical effects of hormone replacement therapy on breast tenderness in postmenopausal women
Breastfeeding and Pumping Problems
Breastfeeding is probably the single most common context for severe nipple pain, and the causes range from easily fixable to genuinely complex. The most frequent culprit early on is an improper latch. When a baby does not take enough of the areola into their mouth, the nipple bears concentrated pressure and friction with every feed, leading to cracking, blistering, and pain that can be intense enough to make people stop nursing altogether.
Breast pump fit is another underappreciated factor. If the flange, the funnel-shaped piece that sits against the breast, is the wrong size, the nipple can be compressed, stretched, or rubbed against the tunnel walls with each suction cycle. A pilot study comparing newer precision-fit flanges to standard sizing found that participants using the standard sizes had significantly less comfort and also expressed less milk, suggesting that a poor fit does not just hurt but also interferes with milk removal.5Journal of Human Lactation. Flange Size Matters: A Comparative Pilot Study of the Flange FITS(TM) Guide Versus Traditional Sizing Methods If pumping hurts, trying a different flange size before anything else is a reasonable first step.
A less well-known cause of sudden nursing pain is a ductal obstruction, sometimes called a milk bleb or blister. In case reports, breastfeeding patients experienced breast and nipple pain alongside a noticeable drop in milk flow. Both patients were able to dislodge a small stone-like object from the nipple opening, which immediately restored flow and relieved the pain.6Journal of Mammary Gland Biology and Neoplasia. Recurrent Nipple Duct Obstruction in Two Breastfeeding Patients These obstructions are poorly studied but commonly discussed in lactation support communities, and they can be surprisingly painful for such a tiny blockage.
Vasospasm, or Raynaud’s phenomenon of the nipple, is another source of sharp, burning pain during or just after feeds. Cold temperatures set it off: blood vessels in the nipple constrict, the nipple blanches white, and then turns blue or red as blood flow returns. All of the women described in one clinical series suffered from extremely painful breastfeeding, with symptoms clearly triggered by cold and accompanied by that characteristic color change.7PubMed. Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding The good news is that vasospasm responds well to warmth, and in stubborn cases a calcium-channel blocker like nifedipine can help. The condition also occurs outside of breastfeeding, particularly in people who already have Raynaud’s in their fingers and toes.
Skin Conditions and Contact Allergies
The skin of the nipple and areola is thin and sensitive, which makes it a frequent site for dermatitis. Nipple eczema can appear as itchy, red, sometimes weepy patches, and it can be maddening to treat when the trigger is not obvious. In a series of allergic contact dermatitis cases presenting as nipple eczema, patch testing revealed reactions to components in clothing, cosmetics, and topical medications applied to the breast area.8PubMed Central. Nipple eczema: a diagnostic challenge of allergic contact dermatitis Laundry detergent, fabric softener, body lotion, nipple cream, and even the dye in a bra can all be the hidden culprit.
Beyond garden-variety eczema, the nipple-areola complex can host rarer skin conditions. A case series from China documented lichen planus, lichen sclerosus, primary cutaneous amyloidosis, and pemphigus vulgaris all presenting on the nipple, conditions that are rarely reported at this site and can be mistaken for more common problems.9PubMed Central. Skin diseases of the nipple and areola complex: A case series study from China If a rash on the nipple does not respond to standard eczema care within a few weeks, or if it keeps coming back, seeing a dermatologist for a closer look and possibly a biopsy is a reasonable next step.
Infections
Nipple infections most commonly show up in the context of breastfeeding, but they can happen to anyone with cracked or broken skin in the area. Candida, the same yeast behind vaginal yeast infections and oral thrush, is a well-recognized cause of burning, stinging nipple pain that often persists between feeds. A cohort study of breastfeeding women in Melbourne found that those with symptoms consistent with nipple or breast thrush were significantly more likely to have Candida species on nipple, breast milk, or baby oral samples compared to women without symptoms. Candida colonization roughly doubled the risk of developing the symptom pattern. Interestingly, Staphylococcus aureus was extremely common on both symptomatic and asymptomatic women, appearing in about four out of five participants regardless of pain, so its role as a standalone cause of nipple pain appears less clear-cut than is sometimes assumed. Nipple damage itself was also an independent predictor of thrush-like symptoms, suggesting that preventing and treating cracks early can break the cycle.10BMJ Open. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia
Outside of breastfeeding, bacterial infections can develop in piercing sites, in cracked skin from eczema, or following minor trauma. The nipple’s warm, slightly moist environment makes it hospitable to bacteria once the skin barrier is compromised. Signs of infection include increasing redness, warmth, swelling, pus, and pain that is getting worse rather than better. A course of antibiotics or antifungals, depending on the organism, usually clears things up, but untreated infections can progress to a breast abscess that requires drainage.
Medications That Trigger Nipple and Breast Pain
Several categories of medication can cause breast tenderness and nipple sensitivity as a side effect. Hormone-based treatments are the most obvious: combined oral contraceptives, progesterone-only pills, fertility drugs, and hormone replacement therapy all alter the hormonal environment in ways that can make breast tissue swell and ache. As noted with HRT, the effect is often transient, peaking in the first weeks and then settling, but it can be severe enough to prompt some people to stop the medication.4PubMed. Paradoxical effects of hormone replacement therapy on breast tenderness in postmenopausal women
Less intuitively, certain antidepressants (particularly SSRIs and SNRIs), antipsychotics, and some blood pressure medications can raise prolactin levels or alter estrogen metabolism enough to cause breast soreness. Spironolactone, commonly prescribed for acne and hormonal hair loss, has anti-androgen effects that can lead to breast tenderness in both men and women. If nipple pain appeared around the time you started a new medication, that connection is worth raising with whoever prescribed it. A dose adjustment or switch to a different drug in the same class often resolves the issue without sacrificing the treatment benefit.
Nipple Pain in Men and Adolescent Boys
Nipple pain is not exclusively a concern for women, and men often delay seeking help because they assume the symptom is irrelevant to them. Pubertal gynecomastia is probably the most common cause in adolescent boys. The temporary breast tissue growth that affects up to half of boys during puberty can produce a firm, often tender disc behind one or both nipples, and the soreness can last for months.2PubMed Central. Endocrine Hormones and Their Impact on Pubertal Gynecomastia While the condition is overwhelmingly harmless, it can cause significant anxiety, and reassurance from a doctor that the tissue will likely regress on its own is an important part of management.
In adult men, nipple pain can result from the same friction and dermatitis causes that affect women. Runners and cyclists are particularly susceptible to chafing. Gynecomastia in adult men is less common than in adolescents and more likely to be linked to medications (anabolic steroids, anti-androgens, certain heart drugs), liver disease, or hormonal imbalances that deserve investigation. Male breast cancer, though rare, does exist, and any new lump, skin change, or persistent nipple discharge in a man should be evaluated.
Rare but Serious Causes
Most nipple pain is nothing to worry about, but a few conditions need to be ruled out. Paget’s disease of the nipple is an uncommon form of breast cancer that begins in the skin of the nipple itself, often masquerading as a stubborn rash. It accounts for a small fraction of all breast cancers, roughly half a percent to four percent of cases, and typically presents with progressive eczema-like changes of the areola, itching, pain or burning that does not respond to standard creams, and sometimes ulceration.11PubMed Central. Clinicopathologic Evaluation of Mammary Paget’s Disease Because it looks so much like ordinary eczema or dermatitis, it is frequently misdiagnosed for months. The key warning signs are a unilateral rash (affecting just one nipple), skin changes that persist beyond a few weeks of treatment, and crusting or bleeding that keeps returning. Paget’s disease is classified as an adenocarcinoma of the nipple’s surface layer and is often associated with an underlying breast cancer deeper in the tissue.12PubMed Central. Mammary Paget’s Disease of the Nipple: Relatively Common but Still Unknown to Many
Other nipple lesions can produce pain alongside discharge. Squamous metaplasia of the lactiferous duct, for instance, can present as a red, painful nodule with purulent discharge. Erosive adenomatosis of the nipple, a benign but alarming-looking condition, often shows up with nipple erosion and serous or bloody discharge, raising concern about an underlying tumor. In one contemporary series, about two-thirds of patients with these lesions had symptoms, though fewer than one in ten reported nipple pain or itching specifically; bloody discharge was the more common complaint.13Advances in Anatomic Pathology. Nipple Lesions of the Breast: An Update on Morphologic Features, Immunohistochemical Findings and Differential Diagnosis
It is also worth noting that breast cancer itself rarely presents with pain as its first symptom. Research suggests that only about six percent of women with breast cancer report breast pain as their primary complaint in the absence of metastatic disease.14Anesthesiology Clinics of North America. Postmastectomy and Postthoracotomy Pain Pain that is bilateral, cyclical, and tied to your menstrual cycle is almost certainly hormonal. Pain that is persistent, one-sided, associated with a new lump, skin dimpling, or bloody discharge is the kind that merits imaging and a clinical exam.
Nerve-Related and Post-Surgical Pain
Nipple pain can also have a neurological origin. The intercostal nerves that supply sensation to the breast and nipple can be damaged or irritated by chest wall injuries, thoracic surgery, or even prolonged poor posture. After breast surgery, including mastectomy, lumpectomy, reduction, and augmentation, some people develop chronic pain in the nipple or surrounding skin that persists well beyond normal surgical healing. This post-surgical neuropathic pain can feel like burning, stabbing, or electric-shock sensations, and it is distinct from the dull ache of tissue healing.
Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, can also refer pain to the breast and nipple area. The pain is typically reproduced by pressing on the chest wall and tends to worsen with certain movements or deep breathing, which helps distinguish it from pain originating in the breast tissue itself. Physical therapy, stretching, and anti-inflammatory medications are the standard approach.
When a Persistent Rash Warrants a Biopsy
One of the trickiest clinical situations is a nipple rash that just will not clear up. The differential between benign eczema and Paget’s disease is important enough to deserve its own emphasis. Atopic or contact dermatitis of the nipple is common and typically responds within two to four weeks to removing the offending irritant and applying a mild topical steroid. Paget’s disease, by contrast, tends to progress steadily, involving thickening, crusting, and sometimes retraction of the nipple. It almost always affects one side only.
A practical rule of thumb: any nipple rash that persists for more than three to four weeks despite appropriate treatment, or any unilateral rash that looks eczematous but is not responding to steroid cream, should be biopsied. The biopsy itself is straightforward, usually a small punch biopsy done under local anesthesia, and it gives a definitive answer. Given that Paget’s disease can be associated with deeper breast malignancy, catching it early makes a real difference in treatment options and outcomes. The condition remains under-recognized even among clinicians, which is part of why diagnosis is often delayed.12PubMed Central. Mammary Paget’s Disease of the Nipple: Relatively Common but Still Unknown to Many