When someone experiences hard, painful nipples, their first concern may be whether this is evidence of a severe health problem. The good news is that nipple pain is rarely a symptom of cancer or another serious disease.
It is normal for nipples to become irritated during certain activities, such as sports. This can usually be resolved with simple remedies or lifestyle changes.
Here, we explore common causes of nipple pain, management of symptoms, and when to see a doctor.
Sometimes, it is natural for a nipple to become hard. In many cases, associated pain can be avoided or managed. Reasons for hard nipples include:
1. Exercise and sports
Exercise can cause nipple friction and pain.
This is especially true for women who exercise without a sports bra, or with a poorly fitting sports bra.
This type of friction can cause soreness, dryness, irritation, and bleeding.
Long-distance runners who exercise excessively and surfers who do not wear rash guards may experience similar symptoms.
2. Allergies and sensitivities
The nipples are among the most sensitive parts of the body and will react differently to stimuli. Sensitivities to weather changes and certain fabrics, including wool, can cause pain and itching in the nipples.
Soaps, lotions, and laundry detergents can cause allergic reactions as well as itchiness. They can also cause the nipple to appear red or chapped.
3. Sexual activity
Strong and forceful friction during sexual activity, including intense oral stimulation, can cause nipples to be tender and sore. This is usually temporary and will likely resolve on its own.
Breast-feeding can cause a condition called mastitis, which is relatively common. Symptoms include nipple chafing and cracking, which may cause breast tissue to become infected and inflamed. Anyone who experiences this should consult a doctor for evaluation and treatment.
Applying a lanolin cream between feedings can help the skin to retain moisture. It is also a good idea to keep nipples clean and dry.
Nipple pain can be a symptom of nipple thrush, a type of candidiasis caused by Candida yeast. This is also common in people who are breast-feeding. Other symptoms include burning, stinging, cracking, and soreness.
Thrush can be transferred between the breast-feeding parent and child. Both should be treated. Breast-fed babies with thrush may have white patches in their mouths.
Soreness and tenderness of the nipples and breasts are typical during pregnancy. This is particularly true during the first trimester, though similar symptoms may occur in the third. A well-fitting support bra can help minimize chafing, pain, and itchiness.
7. Menstrual cycle
Nipple tenderness and soreness tend to occur when levels of progesterone increase. These levels rise about a week before a period begins. Pain, sensitivity, and other symptoms will subside when hormone levels normalize.
8. Perimenopause and menopause
As women start to go through perimenopause and enter menopause, breasts and nipples can become very sore, tender, or otherwise sensitive. This is a result of shifts in hormones.
9. Birth control
Some side effects of birth control pills are similar to symptoms of pregnancy. They tend to resolve once the body becomes accustomed to the medication, which usually takes a few months. If these side effects do not resolve with time, bring them to a doctor's attention.
10. Certain medications and herbs
Some herbal remedies, including those used to promote breast milk, can also cause nipple pain, sensitivity, and tenderness.
11. Duct ectasia
Duct ectasia tends to occur most often in women close to menopause, according to the American Cancer Society. The condition is not related to breast cancer and does not increase a woman's risk of developing cancer.
Duct ectasia occurs when a milk duct becomes enlarged and blocked, causing changes in the nipple that lead to tenderness, redness, itchiness, pain, and thick discharge.
The condition may develop into mastitis or another type of breast infection. Antibiotics may be used for management. In rare cases, blocked ducts require surgery.
12. Breast abscesses
A breast abscess is a collection of pus in the breast and may be linked to breast-feeding or mastitis. Abscesses can also result from nipple piercings or other breaks in the skin that allow bacteria to enter breast tissue.
Breast abscesses can cause nipple pain, redness, warmth, swelling, and a fever. A healthcare professional should drain them. Small abscesses can often be drained with a needle and syringe, while larger ones require an incision.
Eczema can cause itching and pain in one or both nipples. Nipples with eczema tend to look flaky, crusty and red, and discharge is possible.
This eczema can be treated with topical hydrocortisone, but before trying over-the-counter medications, see a doctor for a diagnosis. Other conditions, including cancer, can mimic eczema.
14. Reynaud's phenomenon
Reynaud's phenomenon is common in people who breast-feed. However, it is not caused by breast-feeding, and anyone can develop its symptoms.
In people with Reynaud's phenomenon, the arteries that supply blood to the nipples spasm. Restricted blood flow causes numbness, burning, and pain and the skin's color changes to white and blue. It then turns reddish when blood flow is restored.
15. Paget's disease
Early symptoms involving the nipple include redness and crusting. Any of the following may also be present:
- change in nipple shape
- bloody or yellow-tinged discharge
When other areas of the breast are not affected, the most common treatment involves a combination of
16. Breast cancer
Nipple pain rarely signals breast cancer, but this and other nipple symptoms can indicate the presence of the disease.
Pain, redness, scaling, thickening, and discharge from the nipple are all possible symptoms of breast cancer, according to the American Cancer Society.
Both men and women experience nipple pain. Men commonly experience this pain following injuries, often from sports or accidents. Men can also develop irritated nipples after exercising, due to friction. Men are also at risk for breast mastitis.
Men are at less risk of developing breast cancer, but the American Cancer Society estimates that in 2018, there will be approximately 2,550 new cases of breast cancer in men.
Men with breast cancer may experience the following symptoms in the nipple:
- scaly skin
It is important for men to be screened and maintain a healthful lifestyle, particularly if they have a high risk of developing this cancer. Family history may be a factor.
Many home remedies have been used to ease sore and painful nipples. These include:
- cold teabags
- warm compresses
There is no evidence that these remedies are consistently useful, but some may provide relief, depending on the cause of symptoms. In the event of any changes to the nipple, seek proper diagnosis and medical treatment.
If symptoms occur after exercising, a person can apply a topical barrier product designed for athletes to the skin. Do so before the next workout, to reduce friction.
If symptoms follow the use of a new skincare product, including shampoo, stop using the product and see if the symptoms resolve.
While pain and other symptoms in the nipple can be uncomfortable, they rarely signal cancer.
These symptoms may resolve on their own, or they may be easy to manage. Any questions about the source of nipple pain should be brought up with a doctor.
Women and men who cannot identify the cause of nipple symptoms and are at risk of breast cancer should consult a doctor, particularly in the event of pain and discharge.