Updated: Dec 2, 2019

Nipple pain affects 34-96% of breastfeeding women. During the first days of breastfeeding some discomfort could be expected. Even when it is very common, pain is never normal and should be addressed promptly.

If you are experiencing sore nipples, you must consider the three aspects that relate to pain: external influences, local stimulation, and psychological changes.

External influences

This refers to the factors outside the breast. These causes are usually related to pain exclusively during feeds and the most common causes are the improper attachment of the baby to the breast, misalignment of baby's body during breastfeeding, and less commonly anatomical anomalies like tongue ties that can cause the suction forces to be too strong or on the contrary ineffective needing more time to feed. Increasing friction and trauma make the development of breast problems more common and lead to frustration of the mother and the baby.

Another external influence could be the use of creams that could irritate the tissues. Or devices like breast pumps, whose flanges size should be carefully selected to fit well to avoid pain during use. The prompt assistance of a lactation consultant can correct this problem and prevent the progression and harm of the breast tissues which is highly related to breastfeeding.  

Local stimulation

If external causes are not corrected on time, it's possible to develop breast problems, and one of its characteristics is that the pain is present even in the pauses between feeds, this is caused by the rupture and inflammation of local tissues. Fissures, cracks, and blisters, can be seen on the surface of the nipple as well as redness and swelling.

If this happens, it is essential to rule out bacterial or fungal infections, which will have particular medical treatments. If an infection is ruled out, culturally accepted treatments to promote healing are widely used to treat cracked nipples. However, most of them are not backed up with proper research. Among them, with some degree of evidence are the use of Aloe vera, tea bags, extra virgin coconut oil, Vitamin E oil, olive oil, peppermint extract, curcumin, Saquez ointment (Pistacia atlantica) and jujube extract (Ziziphus jujuba). Even when some research support that they promote faster healing its effectiveness hasn't always been proven on nipple tissues or at all, and the effects of the possible ingestion by babies has rarely been determined and could compromise the efforts of keeping breastfeeding exclusively during the first months of life.

The most natural and fast alternative is the application of a few drops of breast milk under nipple shells between feeds. If infection or maceration is evident, air drying the breast milk could be more beneficial. Even if this technique has not been proven superior facing others, it's undoubtedly harm-free for the breastfed baby.

A better researched and sometimes superior alternative is Purified Lanolin, a wax produced by sheep that is refined to remove any toxins and bacteria. It can be applied directly to the nipple after every feeding to improve the healing of tissues, as the skin repair has shown to be better if occurring in a moisture environment. However, even when it's a natural alternative it's not vegan-friendly.

Also based on the suitability of the liquid environment for wound healing, hydrogel patches can be used between feeds if directed by your physician.

Some other conditions that could be present in the breast are vasospasm, characterized by pale and painful nipples and the infection by the herpes virus that could cause blisters, these diseases are rare and will need medical treatment.

Psychological modulation

All the pain we experience is transmitted from receptors in our body to our brain, where is interpreted and modulated to be perceived as more or less severe. Our own experiences, our mental and spiritual state can affect how we perceive pain. For example, pain during labor is immense but can be diminished by thinking about the birth of our child. On the contrary, a needle poke is not the worst pain imaginable but being scared of it could significantly increase our perception of it. Major psychological situations like depression and abuse related trauma can be triggered by breastfeeding and could affect our perception of pain. It's important to consider this when assessing the cause of pain during breastfeeding to understand whether we are scared, stressed or exhausted because all of those will alter our perception of pain and our ability to successfully breastfeed.

To experience pain during breastfeeding is common, but it's not normal, and so you should not “bear with it”, there is a lot of people around you that is willing to assist you and will help you to succeed at breastfeeding, hopefully with prompt intervention.

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