Why are my nipples sore? 7 possible causes

Nipple pain is a common complaint, especially in pregnant, menstruating, or breast-feeding women. But there are other reasons for nipple pain.

Some people have pain they describe as sharp or accompanied by itching. Others say their nipples just feel sore, sensitive, and tender. Any nipple pain accompanied by a nipple discharge, lumps, or changes in the color or texture of the skin on your breast needs to be investigated by a doctor straight away.

The following are the most common reasons for nipple pain:

1. Menstruation
2. Pregnancy
3. Breast-feeding
4. Infection
5. Cancer
6. Friction during exercise
7. Allergy (to washing powder or fabric softener)

1. Menstruation

The hormonal changes that occur as part of a woman’s normal monthly cycle can trigger nipple pain and breast soreness. Both estrogen and progesterone levels increase just before a woman’s period starts. Both these hormones draw fluid into the breasts making them feel swollen and tender. Estrogen causes breast ducts to enlarge and progesterone causes milk glands to swell. Nipple pain during this time is also common.

Symptoms often peak just before menstruation and then fade and resolve during menstruation. The severity of symptoms can vary from woman to woman but in most cases it is more of an annoyance rather than a serious medical concern. However, if you notice any discharge from the nipple, especially if discharge is brown or bloody, see your doctor.

2. Pregnancy

Pregnancy causes several breast and nipple related changes, for example:

• Nipple tenderness and hypersensitivity
• Darkening of the nipples and areolas (the skin around your nipples)
• Enlargement of the areolas and nipples, and nipples tend to stick out more
• Small glands on the surface of the areolas (Montgomery’s tubercles) may become raised bumps
• Breast growth and enlargement
• Darkened veins along with the breasts due to the increased blood supply to your breasts
• A yellowish, thick discharge from the breasts (this is known as colostrum).

3. Breast-feeding

It is not uncommon for nipples to feel sore and tender after breastfeeding; especially in the first few minutes when the baby first latches onto the breast. However, nipples should not remain sore or bleed for long periods of time.

If your nipple pain is severe or continuous or recurs then this may be caused by a technique problem, which should be corrected. Technique problems include:

• The baby is not taking in the areola as well as the nipple
• Problems with latching on
• Improper positioning
• A poor let-down reflex in the mother
• Inverted nipples
• Babies sucking for comfort and falling asleep at the breast
• Pulling the baby's mouth away from the breast without first breaking the suction
• Babies with short frenulum (the frenulum is the piece of tissue that connects the tongue to the bottom of the mouth), also known as being "tongue-tied".

Modified lanolin, cold compresses, hydrogel pads, and breast shields may help to reduce pain. But you should always seek further advice from a lactation consultant or doctor who can help you with your breastfeeding technique.

Related questions

• What is the strongest chemotherapy drug for breast cancer?
• How long do letrozole side effects last?
• What happens when you stop taking letrozole?

4. Infection

A yeast infection (also called thrush) is the most common type of infection that can occur on your nipples. Around your nipples there are large pores and hair follicles that can become clogged and infected. Yeast infections are more likely to occur in areas that are moist and dark where sweat collects, such as under the breasts; however, women who wear bras made of non breathable material may also develop yeast infections on their nipples too.

Women who are breastfeeding are particularly prone to yeast infections on their nipples, and also breast infections, such as mastitis. If you are breastfeeding and develop sore nipples or breasts then talk to your doctor.

Infections can also occur in men or women with nipple piercings, especially if piercings are not done with good technique or cared for properly afterwards.

5. Cancer

Paget’s disease is a type of cancer that may cause nipple pain. It usually only affects one nipple and the same breast and is rare. The following other symptoms may also be present, including:

• An inverted or flattened nipple
• A yellowish or bloody discharge from the nipple
• Nipple itching or tingling
• Skin changes, such as reddish, flaky, crusty, or scaly skin around the nipple and areola.

If you have any symptoms such as those described above with your nipple pain, see your doctor.

6. Friction

Nipple chafing as a result of friction is common during running or other active forms of exercise, particularly in men who wear rough cotton shirts or in women wearing ill-fitting bras or bras made of lace or cotton.

Sweating also softens the skin, and the salt in your sweat can crystallize and provide another source of irritation. Over the course of a long run or workout, your nipples can be rubbed to the point of bleeding.

Chafing usually causes a stinging nipple pain, and the skin may also become dry or chapped. Wearing synthetic fabrics close to your skin that wick away sweat can help reduce nipple chafing as can applying a lubricant or antichaffing cream to the nipples before exercise. Covering the nipples with surgical tape or a nipple cover may also help.

7. Allergy

If the skin around your nipples is flaking and crusty or blistering, you may be experiencing an allergic reaction or atopic dermatitis (eczema). Nipple allergies can develop to:

• Body lotion
• Fabric softener
• Fabrics
• Laundry detergent
• Perfume
• Shaving cream or rough facial hair rubbing against your nipples.

If the nipple pain has come on suddenly, try to work out if anything has changed for you recently, for example, a new laundry detergent, body lotion, or perfume. Try not using it for a week to see if that makes any difference to the nipple soreness.

A topical anti-inflammatory may help for a few days but speak to your doctor if the soreness persists or worsens.