Causes of Nipple Pain

Everything you need to know about pain in the nipples

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Nipple pain can be a sensation of aching, tenderness, tingling, throbbing, or burning. It may or may not accompany more general breast pain and it can happen in men as well as women. Depending on the cause of the nipple pain, it can include the areola, the ring of pigmented skin around the nipple.

Nipple pain can come from several different causes, but most are not serious. Most commonly, nipple pain comes from some sort of trauma to the nipple, and sometimes that trauma can be subtle and tricky to recognize. The most important way to identify a cause of nipple pain is to consider what you were doing right before the pain started. Some will be obvious causes, others will not.

The most common traumatic causes of nipple pain are breastfeeding, sexual activity, or "jogger's nipple." Nontraumatic nipple pain is less common. It's still not likely to be serious, but there are signs to look for. It is often caused by the same things that can cause more generalized breast pain. If you are experiencing breast pain as well as nipple pain, see the causes of breast pain for a more in-depth look.

Causes

Nipple pain can be divided into traumatic—pain from an injury—and nontraumatic pain. Traumatic pain causes are easier to identify and to treat, and are not dangerous. Nontraumatic nipple pain is also very unlikely to be significantly dangerous.

All of the most common causes of nipple pain are non-life-threatening, although some do benefit from being treated by a doctor.

"Jogger's Nipple"

Jogger's nipple is a friction burn that comes from clothing rubbing on the nipples. It's very common in runners, especially new runners. Usually, it affects both nipples and the irritation can get pretty raw. In the worst cases, the nipples can bleed. This can affect both men and women. The treatment is to keep the nipples covered and moist, like a burn—time will heal this one.

For women, the right sports bra will often help avoid future nipple irritation. Sorry, gentlemen. The good news is that most seasoned runners don't complain of this type of nipple pain, so the best all-around thing to do is to keep running.

Friction burns can lead to nipple pain even when there was no running involved, and mostly come from ill-fitting bras. Try different undergarments to prevent the irritation. Moisturizer and time will heal those nipples. For any kind of friction burn, either one or both nipples can be affected.

How to Prevent and Treat Chafed Nipples While Running

Infections

Mastitis is an infection of the mammary ducts and can be a cause of nipple pain or of more general breast pain. The nipples can become infected from other skin infections as well, especially if they are already irritated or chapped. Yeast infections are also fairly common in the nipples, especially for women who are breastfeeding.

Hormonal Changes

Premenstrual nipple pain or nipple soreness during pregnancy is very common. Usually, fluid shifts in mammary ducts cause swelling, which then causes nipple pain and can also cause more generalized breast soreness. Hormonal nipple pain is completely normal.

Sexual Activity

Just like friction and breastfeeding, nipple play during sex can lead to irritation and nipple pain. Usually, this problem only lasts for a short duration and will likely go away with a little time to heal. Again, moisturizer is helpful during the healing process.

Breastfeeding

Breastfeeding is a well-known cause of nipple pain. The same chapped, irritated, painful, and sometimes bleeding nipples that come with friction burns can also happen with both breastfeeding and expressing (pumping). The right technique can help avoid the irritation.

How to Avoid Sore Nipples While Breastfeeding

Atopic Dermatitis

Atopic dermatitis is also known as eczema, a condition that leads to flaky, itchy skin. Atopic dermatitis can affect the nipples as well as the breasts. It's relatively common to find atopic dermatitis on the nipples and areolas. It can happen to one or both nipples.

Most patients that have atopic dermatitis of the nipple also have atopic dermatitis on other parts of their bodies. Eczema can be difficult to treat. There are some over-the-counter medications, but a trip to the doctor might be necessary for particularly stubborn cases and because, in very rare cases, it could end up being Paget's disease (see below). Atopic dermatitis that only affects the areola has no chance of being Paget's disease. The nipple must be involved.

Allergic Reactions

Some people develop allergies to soaps, laundry detergents, conditioners, or lotions that end up causing a rash, redness, or itching. Nipples are often the first to get irritated by new allergies and the first sign could be nipple pain.

Sunburns

Sunburns can happen, especially for nipples that don't often see the light of day. This is a potential for both sexes when going topless. Don't forget the sunscreen.

Rare Causes of Nipple Pain

Some causes of nipple pain are less common and most of these require a visit to the doctor for proper diagnosis. Other than obvious chapping or irritation such as described above, if nipple pain is accompanied by any sort of malformation or discharge (stuff coming out of the nipple other than during breastfeeding), see a doctor.

Paget's Disease

Nipple pain that comes with an inverted nipple or a lesion on the nipple or areola can be Paget's disease. Paget's disease can affect the mammary gland or be extramammary (outside the mammary gland). When the nipple is involved, it's considered mammary Paget's disease (MPD), which has a very high association with cancer. Paget's disease requires diagnosis by a doctor, usually after doing a biopsy. Usually, Paget's disease only affects one side.

Erosive Adenomatosis of the Nipple (EAN)

Erosive adenomatosis of the nipple is a benign tumor of the nipple that requires diagnostic tests to be able to differentiate it from Paget's disease. It is the differential diagnosis (the condition that has to be ruled out) in order for a doctor to diagnose Paget's disease.

When to See a Doctor

Most nipple pain that has no other signs or symptoms, or has obvious irritation and an obvious cause, can be treated at home. The most common treatment is simply time.

Nipple pain by itself does not usually need a doctor's care. If the pain is unbearable or continues for more than 72 hours and the patient has stopped any activity that might be causing the nipple pain, see a doctor.

Breastfeeding mothers should speak to a lactation consultant or the baby's pediatrician. In some cases, the baby could have a short frenulum, a thick bit of tissue attached to the base of the tongue, which can get in the way of the baby latching onto the nipple properly when breastfeeding. If that's not the case, the doctor or lactation consultant can help with techniques to improve both feeding and nipple care.

When nipple pain is accompanied by growths, discharge, inverted nipples, or the nipple is warm to the touch, see a doctor. If the pain has no obvious cause and only affects one nipple, see a doctor.

Diagnosis

To diagnose nipple pain, the doctor will perform a history and physical exam. Traumatic causes of nipple pain will be ruled out first. Some causes are easy to determine, such as friction burns, hormonal changes, or breastfeeding. The doctor might have to prescribe tests such as imaging or biopsy to determine the cause of the nipple pain.

Labs and Tests

Imaging tests and biopsies are the two most common types of tests that doctors might prescribe for nipple pain. Imaging tests can include mammograms or ultrasounds.

Treatment

Time is the most common treatment for nipple pain. In most traumatic cases, nipple pain heals on its own as long as the activity that led to the irritation is corrected.

Other treatments depend on the cause of the nipple pain and might require a doctor to guide the treatment.

A Word From Verywell

Nipple pain is very common and not dangerous, especially when related to hormonal changes. If the pain is caused by an activity, either take steps to avoid that activity or find out how to address the irritation it is causing.

Treat Sore Nipples From Breastfeeding With Creams and Moisturizers
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