Nipple soreness

Many women experience nipple soreness at certain times. It can be caused by various reasons, because nipples are one of the most sensitive areas of the body. And in many cases, hormones are to blame. So, nipple soreness in the middle of the cycle in women of childbearing age is one of the signs of pregnancy.

However, the matter is complicated by the fact that it can also be a symptom of a disease. Most symptoms are not assigned a code according to ICD 10. And from a medical point of view, soreness is the occurrence of discomfort and a feeling of pain with any physical impact, such as touch, pressure or palpation by a doctor.

Causes nipple soreness

All causes of nipple soreness can be divided into hormone-dependent and hormone-independent. Cyclic soreness reflects the condition of the mammary glands, which is determined by the level of steroid hormones such as estrogen, estradiol, progesterone, prolactin, and luteotropic hormone produced by the pituitary gland.

Hormonal causes of nipple soreness, which manifests itself as monthly discomfort in women's mammary glands and soreness in the nipple area, is a sign of natural hormonal fluctuations during the menstrual cycle (and part of premenstrual syndrome). For more information, see - Breasts before menstruation, and - Breast pain before menstruation.

Sore nipples in the middle of the cycle are also most often associated with menstruation, since many women's bodies begin to prepare for ovulation (the release of a mature egg from the ovary) around the middle of the menstrual cycle. This process takes from several days to a week or more after the last day of menstruation. If women have been using hormone-containing medications to prevent unwanted pregnancy for a long time, they may also experience symptoms of sore nipples.

Gynecologists explain the soreness of the nipples after ovulation by a sharp reduction in the production of estradiol and progesterone.

Pain in the nipples after menstruation of varying intensity can be a sign of pregnancy, for more details see – Pain after menstruation, or a symptom of fibrous formations in the mammary gland. And nipple pain during menopause is a consequence of age-related decline in hormonal levels. But even if estrogen levels in the body before menopause are lower than before, it remains the dominant sex hormone in the female body, and the first signs of impending menopause can manifest themselves as painful sensations in the nipples.

Special cases of periodic painful sensations in the area of juices include women who have undergone hysterectomy operations, during which the cervix and ovaries were not removed. According to medical statistics, complications of such operations in 90% of patients are various pathologies of the mammary glands, including fibrocystic mastopathy.

[ 1 ], [ 2 ], [ 3 ]

Pathogenesis

The pathogenesis of non-cyclic pain does not have a hormonal factor. On the upper part of the nipple there are more than a dozen milk pores that work actively only during lactation, and the skin of the nipples is tender and sensitive, as it is supplied with many nerve endings. Pain in the nipples during feeding is caused by their cracks - see the detailed article Pain in the nipples of the breast.

Any traumatic effect can lead to painful sensations outside the period of breastfeeding - synthetic fabrics or bra seams, detergents, etc. In addition, non-hormonal-dependent causes of nipple soreness include such dermatological pathologies as:

• allergic or idiopathic eczema, see - Eczema on the nipples;
• nipple skin lesions caused by Streptococcus agalactiae and the development of streptoderma (impetigo);
• superficial candidiasis;
• localized herpesvirus lesion on the nipple;
• folliculitis (inflammation of the hair follicles of the areola located close to the nipple).

Due to the gradual involution of the mammary glands in mature women, pain in the nipple area may develop due to the expansion of the milk ducts - for more details, see Ectasia of the milk ducts.

The most dangerous cause of nipple pain is Paget's disease (cancer), the signs of which at first are very similar to the symptoms of eczema.

Sore nipples in men also have many causes, among which doctors note: direct trauma to the nipple; constant irritating friction of the nipple by tight-fitting sportswear (runner's nipple syndrome); gynecomastia (enlargement of the mammary glands due to an imbalance of male and female hormones in the body); taking anabolic steroids.

But in teenagers and young men, nipple soreness when touched has a hormonal nature, and after the onset of sexual activity, this condition disappears without a trace. However, with excess weight or in the presence of diabetes, symptoms of nipple soreness can manifest for years.

If non-cyclic nipple soreness is left untreated, complications may arise that depend on the nature of the infection and may lead to the development of a serious inflammatory process. Its consequences may result in various types of mastopathy, which will require surgical treatment.

[ 4 ], [ 5 ]

Diagnostics nipple soreness

Standard diagnosis of nipple pain is based on anamnesis, physical and palpatory examination of the mammary glands.

In cases of nipple soreness associated with lactation, diagnosis is not difficult, and obstetricians and gynecologists successfully cope with this task. But, given the hormone dependence of this condition, in other situations, tests may be prescribed:

• enzyme immunoassay of blood for hormone levels;
• blood test for the presence of IgM antibodies to the herpes simplex virus;
• bacterial culture from the nipple skin for coccal infection and Candida Albicans;

Instrumental diagnostics mainly include mammographic examination (X-ray of the mammary gland) and examination of the condition of the milk ducts (ductography).

If there is reason to suspect Paget's disease, differential diagnostics are performed and a blood test for tumor cell proteins (tumor markers) is taken, and an ultrasound of the mammary gland is also performed.

[ 6 ], [ 7 ], [ 8 ], [ 9 ]

Treatment nipple soreness

The complex of measures, including treatment of sore nipples, must necessarily include prevention. Sometimes it is enough to replace synthetic underwear with cotton or to refuse soap that irritates the skin, and the symptoms of sore nipples quickly pass.

Sore nipples during feeding are caused by cracks, for which doctors recommend external agents that moisturize and soften the skin, as well as promote its regeneration, for example, Panthenol ointment with vitamin B5 and lanolin (trade names - Dexpanthenol, Pantoderm, Panthenol); gel or ointment Actovegin, etc.

Medicines for dermatological diseases that cause pain in the nipple area are prescribed by a dermatologist: for eczema, these are solutions of silver nitrate, zinc sulfate or resorcinol (for treating nipples), as well as ointments with corticosteroids Dexamethasone, Fluorocort, Trimistan, Sinalar, etc. For streptoderma or folliculitis, ointments with antibiotics are needed - Levomekol, Methyluracil, synthomycin emulsion, etc. And in the fight against the Candida fungus, ointments with nystatin (Nystatin, Mycostatin) or imidazole (Clotrimazole, Mycosporin, Funginal, etc.) help.

Specific medications for herpes - Acyclovir ointment (Gerpevir, Zovirax, Violex and other generics) - are exclusively symptomatic, but they are contraindicated for breastfeeding women.

Traditional medicine is also widely used. First of all, it is recommended to apply externally an aqueous solution of propolis (heals cracks and relieves irritation), aloe juice (relieves inflammation), tea tree oil (kills bacteria), and pain-relieving essential oils of geranium, sage, and verbena. For juice eczema, it is recommended to apply a mixture of sunflower oil with salicylic-zinc ointment.

Herbal treatment consists of treating the nipples and the area around the nipples with decoctions of chamomile flowers, calendula and arnica, St. John's wort and celandine, white willow bark and walnut leaves (a tablespoon of dry raw materials per glass of boiling water).

Among the external remedies that homeopathy offers to reduce the intensity of this symptom, it is worth noting ointments based on the same calendula and St. John's wort, comfrey root (comfrey), and internally - Natrium muriaticum (table salt).

Prevention

Prevention of nipple soreness is possible only in cases of its non-hormonal etiology, and the main thing here is personal hygiene, the observance of which can protect against infections. And when a person takes good care of his health, the prognosis is always favorable.

But if nipple soreness develops into constant pain, do not try to solve the problem on your own: the sooner you contact a specialist, the more likely it will be successfully resolved.

[ 10 ], [ 11 ], [ 12 ]