Nipple pain can also be divided by its origin.
Cold, heat, friction, stretching, pressure, suction, excess moisture, and sharp objects can work independently or together to result in skin pain and damage and in tenderness of the tissues underneath.
Some of these same forces act on the nipple skin and underlying tissues while breastfeeding or expressing.
Nipple trauma can be caused by:
- The baby breastfeeding well.
- Problems with the breastfeeding technique.
- The characteristics of the nipple and breast.
- Abnormalities of the nipple and breast.
- How the baby sucks and behaves at the breast.
- Improper use of devices (e.g. nipple shields and breast pumps) or manual expression.
For most first-time mothers, there is no gentle introduction to breastfeeding. Rather the nipples and breasts are suddenly asked to deal with a baby who breastfeeds as often as ten times each day. Nipples are stretched during latching and sucking, experience pressure as the baby’s tongue rises and increased suction as the tongue falls, and are wet during breastfeeding. These forces cause trauma and can result in nipple pain.
2) Skin damage
Nipple skin damage is very painful and takes a while to heal and become pain free. This is most commonly caused by nipple trauma but infection with bacteria and yeast can also cause or extend damage.
Infection of the nipple is painful and can be caused by bacteria, viruses, and yeast.
The most common bacterial infection of the nipple happens when the skin of the nipple is damaged, creating a portal for bacteria. This can happen when the nipple skin is damaged at the start of breastfeeding, by the baby's teeth, or through a Montgomery gland. Viruses can be transmitted by the baby to the mother’s nipples or may be resting in the mother’s body until stress or another cause activates them. Yeast infections take advantage of the increased moisture created by breastfeeding.
The classic signs of infection include:
- Loss of function
Nipple pain can have other causes.
Milk pimples (blebs) are common and related to producing milk but how they form is not known.
Skin conditions found elsewhere on the body, such as eczema or psoriasis, can be present on or near the nipple. New problems affecting the skin, such as cancer, can develop while breastfeeding.
Some causes, such as pregnancy or a return of menses, are hormonal in nature. Some have a nervous system component. Nipple vasospasm is caused by over-reactive blood vessels narrowing and can be brought on by nipple trauma. Nipple pain is more common in mothers who are hypersensitive to touch (hypersensitivity syndrome) or have a personal history of abuse.