Pain or significant tenderness in the nipple when pressure is applied can be startling for males. While this symptom understandably causes concern, it often reflects common, non-serious issues that are easily addressed. Understanding the underlying source of the pain is the first step toward finding relief and determining whether a medical evaluation is required.
Common External and Mechanical Irritations
The most frequent causes of male nipple pain upon pressing involve simple mechanical irritation or physical trauma. The nipple and areola contain a high density of nerve endings, making them highly reactive to outside forces.
Repetitive friction from clothing is a widely recognized cause, often termed “runner’s nipple.” This occurs when a shirt repeatedly rubs against the skin during prolonged activities like running or cycling. This leads to irritation, chafing, and sometimes a superficial fissure in the skin. The pain experienced when pressing is localized damage to the skin barrier caused by this constant abrasion.
Accidental trauma, such as an unexpected bump or an awkward sleeping position, can also cause mechanical irritation by putting sustained pressure on the chest. Harsh cleansing products, like strong soaps or detergents, can trigger contact dermatitis. Applying a protective layer, such as petroleum jelly, before exercise or switching to moisture-wicking, fitted clothing provides effective prevention.
Tenderness Driven by Hormonal Changes
A significant cause of nipple tenderness in males is the effect of shifting hormone levels on the underlying breast tissue. Estrogen, a hormone present in small amounts in males, stimulates glandular breast tissue growth, and an imbalance with testosterone can lead to sensitivity.
This hormonal influence is most often seen during natural fluctuations, such as male puberty, where the pain is transient and resolves as hormone levels stabilize. In adulthood, a persistent imbalance can result in gynecomastia, the benign enlargement of glandular tissue beneath the nipple and areola. This glandular growth makes the area highly sensitive to touch and pressure.
It is important to differentiate true gynecomastia (glandular tissue) from pseudo-gynecomastia (increase in breast size due to fat deposition). Only the true glandular enlargement is directly responsible for the tenderness and pain when pressed. Certain medications (especially those used for prostate conditions or high blood pressure) or conditions like liver or kidney disease can induce these hormonal shifts, leading to painful glandular tissue.
Inflammatory and Skin-Related Conditions
Pain localized to the nipple when pressed can stem from inflammatory or dermatological conditions affecting the skin surface. Dermatitis or eczema, characterized by redness, flaking, and intense itching, can cause the skin around the nipple to become fragile and inflamed. Applying pressure to this compromised skin triggers a pain response far greater than normal.
Folliculitis, the inflammation or infection of the hair follicles around the areola, can create a localized, tender spot. This condition often presents as small, red bumps that are acutely painful when pressed. Infections can enter the breast tissue through small cracks in the skin caused by chafing or irritation, leading to mastitis.
Male mastitis, though uncommon, is an infection of the breast tissue. It causes localized warmth, swelling, and severe pain when pressure is exerted. This infectious process involves bacteria multiplying within the tissue, creating inflammation that is acutely responsive to external force.
Signs That Require Medical Evaluation
While most causes of nipple pain are benign, certain accompanying signs suggest the need for a consultation with a healthcare provider to rule out more serious issues. Persistent pain that does not resolve with simple self-care measures, or pain that is worsening over time, warrants professional evaluation.
The presence of a firm or fixed lump, particularly one felt under or near the nipple, requires immediate investigation. While male breast cancer is rare, accounting for about one percent of all breast cancer cases, a lump is the most common presentation.
Other concerning changes include any visible alteration to the skin of the breast or nipple, such as dimpling, scaling, or unexplained redness. Nipple discharge, especially if it is bloody, clear, or occurs spontaneously without being squeezed, necessitates a medical workup. If the pain is accompanied by systemic symptoms like a fever, chills, or significant swelling, it may indicate a deeper, rapidly progressing infection or abscess requiring prompt antibiotic treatment.