Nipples may become hard and sore due to a number of reasons. Possible causes include exercise, menstruation, allergies, eczema, Paget’s disease, breast cancer, and more.

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.

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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.

4. Breast-feeding

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.

Nipple pain and chafing can occur due to a poor latch of the baby during breastfeeding. A lactation specialist can help with this.

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.

5. 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.

Oral antibiotics play a huge role in treating breast abscesses. Sometimes, a healthcare professional may choose to drain them

6. Thrush

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 breastfeeding parent and child. Both should be treated. Breast-fed babies with thrush may have white patches in their mouths.

7. Pregnancy

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.

8. 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.

9. 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.

10. 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.

11. Certain medications and herbs

Medications prescribed for depression or anxiety have been linked to pain and other symptoms in the breasts and nipples.

Some herbal remedies, including those used to promote breast milk, can also cause nipple pain, sensitivity, and tenderness.

12. 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.

13. Eczema

Eczema can cause itching and pain in one or both nipples. Nipples with eczema tend to look scaly, crusty and discolored. Discharge is also possible.

This eczema can be treated with topical corticosteroids, but before trying over-the-counter medications, see a doctor for a diagnosis. Other conditions, including cancer, can mimic eczema.

14. Raynaud’s phenomenon

Raynaud’s phenomenon is common in people who breast-feed. However, it is not only caused by breastfeeding and anyone can develop its symptoms.

In people with Raynaud’s phenomenon, the arteries that supply blood to the nipple 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

Sore and tender nipples are also a symptom of a rare condition called Paget’s disease, which occurs in 1 to 4% of all breast cancers.

Early symptoms involving the nipple include redness and crusting. Any of the following may also be present:

  • itching
  • tingling
  • sensitivity
  • pain
  • burning
  • 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 surgery and radiation. However, chemotherapy and other treatments may be necessary, depending on the extent of the associated cancer.

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 for 2023, there were approximately 2,790 new cases of breast cancer in men.

Men with breast cancer may experience the following symptoms in the nipple:

  • redness
  • scaly skin
  • retraction

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:

  • massage
  • ice
  • cold teabags
  • warm compresses
  • moisturizers

There is no evidence that these remedies are consistently useful, but some may provide relief, depending on the cause of the 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 skin care 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.

Nipples can become hard for several reasons. Often, they resolve on their own or may be easy to manage.

Sometimes, when nipples become hard, it is a normal reaction, like when a person is playing sports. Other times, it can occur due to allergies, breast abscesses, thrush, or more serious health conditions — including cancer.

A person should consider contacting a doctor if they experience nipple pain, especially people who are at greater risk of breast cancer.