1) Burning pain
Nipple yeast infection begins with a characteristic pain (Francis-Morrill 2004):
- The pain starts on both breasts at nearly the same time.
- There is burning pain in the nipples and areolas during breastfeeding.
- Burning can continue for up to several hours after breastfeeding.
- There are equal amounts of pain in both breasts unless:
- There is a crack where the nipple meets the areola (nipple bottom) on one side but not the other, or
- The mother is only breastfeeding on one breast.
In addition to burning pain, mothers may feel a small amount of itching. They may find that their nipples are extremely sensitive; showers and light touch can be very painful.
2) Shooting or radiating pain away from the nipple
The pain may shoot into the breast. It may also shoot around the outside of the breast and up to the lower part of the shoulder blade during and after breastfeeding (referred pain).
Nipple yeast infections are somewhat unique in their ability to create pain well away from the site of infection. Candida albicans appears to stimulate the nerves that send pain signals to the brain. This stimulates the body’s immune system to fight the infection but may also be the reason for this distant pain (Kashem 2015).
3) Sharp latching pain
Once cracks develop at the nipple bottom, there is a different type of pain. It is severe and sharp and occurs with latching. The previous burning pain during and after feeds will continue or increase.
Cracks caused by a nipple yeast infection can also be complicated by a bacterial infection creating even more pain.