Why Do Our Nipples Hurt?

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Nipples are projections or bumps are found on the chest of both males and females. Nipples mark the opening of mammary glands that drains milk to the nursing infants. The area around the nipple is called the areola and contains smooth muscles that harbour the nipples or teats. Mammary gland consists of alveoli and ducts. The alveoli synthesize the milk which is drained into the ducts and from the ducts the milk comes out through the openings in nipples. The ejection of milk is called ‘œletting down’ process. Hence, nipples are important structures for feeding infants and sexual eroticism.

However, nipple pain is very common and there are a plethora of causes which attributes to such pain. Post-pregnancy, there can be issues with inhibition of letting down process leading to accumulation of milk in the alveoli and ducts which manifests as nipple pain. Normally sore nipples are due to an inflammation and if both nipples are sore, breast cancer is one of the rarest possibilities. Apart from milk accumulation and breast cancer, there are other causes of nipple pain which are shared below.

Working out or exercise can rub the nipples against the apparels develops friction in the nipples. This leads to bleeding, soreness, dryness, irritation and finally pain. Hence, exercising without proper inner wear is one of the common causes of nipple pain. Since nipples are very sensitive it can be prone to allergic manifestations like our skin. Nipples are sensitive and allergic to cold or hot weather, chemicals and body lotions applied on our body that are not tested for human use, and certain fabrics. Friction may also develop during intense sexual activity which may cause nipples to become sore and irritable.

The changes in hormonal levels are also related to nipple pain. The milk ejection reflex is initiated by oxytocin and progesterone. Hence, a decreased level of these hormones, fails to produce contraction in the myoepithelial cells of the alveolar ducts, leading to accumulation of milk with a resultant inflammation, which leads to pain in nipples. The changes in hormonal level or improper feeding leads to blockage of alveolar ducts cause an inflammation, which is termed mastitis. Further, mastitis is also responsible for development of breast abscess, which together causes pain in nipples and areola.

Another rare cause of nipple pain is Paget’s disease. It is a malignant condition that manifests like eczema on the surface of areola and nipples. Further symptoms include straw coloured discharge from nipples with burning sensation and pain and itching in nipples. Paget’s cells are found in the alveolar ducts and a carcinoma in these cells migrates into lactiferous sinuses and the skin of the nipples. The malignant cells disrupt the normal epithelial barrier and extracellular fluids accumulate on the surface of skin, which causes crusting of the skin of areola or nipples. Lumpectomy or radiotherapy can be important treatment plans for Paget’s disease.

Pregnancy is another cause of nipple and breast soreness. It is noted during 6-8 weeks of pregnancy and in the third trimester, when blood supply to the breasts markedly increases due to hormonal changes. This causes the breasts to become fuller and heavier leading to the characteristic soreness. Improper breastfeeding and improper latching can also lead to pain in nipples. Onset of teething in babies can be another common cause of nipple pain.
Fungal infections like candidiasis, atopic eczema and vasospasm in the blood vessels draining the alveolar ducts may also cause nipple pain. Raynaud’s phenomenon, which refers to a lack of blood supply to the nipples, and release of adrenaline during stress, which further constricts blood vessels, may lead to burning sensation and soreness in nipples. Usage of anti-inflammatory ointments, tablets, lanolin, anti-fungal, corticosteroids and proper breast feeding techniques may provide relief from nipple pain.

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