Late-onset nipple pain and areolar pain

Why did my nipple area just start hurting and looking different?

Nipple pain and damage that begin early in breastfeeding are usually related to the baby’s latching and sucking. When they begin later, after weeks or more of pain-free breastfeeding, it is called late-onset. There are many possible causes, including infection, trauma or other skin problems. It is important to have the right diagnosis. These problems can affect different parts of the nipple or areola and one or both breasts. Some causes of late-onset nipple pain are more common than others.

Consider using our quick assessment tool, “Why do my nipples hurt?” to guide you through this concern. 

A) Describing late-onset nipple and areolar pain

Vitiligo. This is painless but has a dramatic appearance.

Mothers’ nipples and areolas may hurt for many reasons. It is important to have the right diagnosis in order to choose the right treatment.

Nipple pain and damage that begins soon after starting breastfeeding (early-onset pain) tends to be related to the mechanics of the baby’s latching and sucking.

Pain that starts after breastfeeding has been established and mothers have been pain free for at least a few weeks after the baby’s birth is called late-onset pain. It is usually not related to routine latching and sucking. Rather, it can be caused by infections, other trauma, or skin problems (Berens 2016).

Some skin problems, such as a loss of colour of the skin (vitiligo), may not be painful or harmful but other changes such as cancer require treatment. 

Please see your health-care providers if you notice any new pain or skin changes. 

D) Frequency

Some causes of late-onset nipple pain are more common than others. 

Table: How Often Problems Result in Late-Onset Nipple and Areolar Pain

Problem

How often problems occur

Milk pimple

Nipple vasospasm

Common

Yeast

Eczema

Clamping and tugging

Less Common

Bites and pressure wounds from teeth

Infected milk pimple

Infected Montgomery gland

Uncommon

Psoriasis

Nipple herpes and shingles

Paget disease, papillary adenoma, cancer

Rare

References

Berens P, Eglash A, Malloy M, et al. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeed Med. 2016 Mar;11(2):46-53