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October 20, 2020
By Andrea Tran RN, BSN, MA, IBCLC
Painful nipples is one of the most common reasons women report for ending breastfeeding before they had planned. There are several different causes of nipple discomfort. Two potential sources of nipple pain are from vasospasms and Raynaud’s Phenomenon. While these two conditions are similar, there are significant differences, and they are treated differently.
A vasospasm occurs when there is a rapid constricting of the blood vessels in the nipple. After breastfeeding, a mother will see her nipple turn very pale or white, which is referred to as blanching. Nipple blanching occurs for all skin colors.
Some degree of pain usually accompanies a vasospasm. The discomfort ranges from mild to severe and is usually described as burning or throbbing.
The vasospasm can be caused by the nipple being compressed or from nipple damage. A thrush infection may also cause vasospasms. The vasospasms should stop once the problem causing the vasospasm is corrected. For example, if a shallow latch is compressing the nipple and causing the vasospasms, improving the latch should improve the vasospasms.
Related: Thrush and breastfeeding
Another source of nipple pain is a condition called Raynaud’s Phenomenon. It is also called Raynaud’s Syndrome or Raynaud’s Disease. A telltale sign of Raynaud’s is two or three color changes of the nipple, but this is only true for white skin. When exposed to cold, the nipples will blanch white, then they turn a blue or purplish color, and may again change to a reddish color. After a few minutes, the nipple returns to its normal color.
Black and brown nipples usually turn white, then back to normal. Because the telltale sign is missing, you may have to rely on other symptoms to guide you.
Raynaud’s can also affect the fingers, toes, nose, and lips. Symptoms in these other body parts can help make Raynaud’s diagnosis for a woman experiencing nipple pain.
About 5% of the population has Raynaud’s disease, 80% of those afflicted are female.
For white skin, Raynaud’s involves at least two color changes as opposed to vasospasm, where the nipple only turns white. Vasospasms go away when the nipple damage is healed. Raynaud’s is caused by the nipple being exposed to cold air and is more challenging to treat.
In addition to the color changes, the nipples will be extremely painful during episodes. The pain is described as burning, stinging, pins and needles, or throbbing. Women often report the pain as being quite intense.
Some of the symptoms are the same as what is experienced with a case of thrush: burning, stinging nipple pain. There have been women who have been repeatedly treated for thrush who have eventually been diagnosed with Raynaud’s. The color changes that occur can help in making the correct diagnoses.
A woman is instructed to apply dry heat to her nipple as soon as she detaches her baby from the breast. A heating pad can be used. Another tactic recommended is for a mother to quickly pinch the nipple base and hold it for several seconds. This is an attempt to prevent the blood from leaving the nipple. Women are also advised to avoid substances like nicotine that can cause vasoconstriction.
Nifedipine is a prescription medication that has been used to successfully treat Raynaud’s. It is a calcium channel blocker and causes the blood vessels to relax. It is a medication that is compatible with breastfeeding.
Some women have anecdotally reported relief from symptoms using a variety of alternative treatments. Research suggests that acupuncture may be helpful, but it has not supported other complementary and alternative treatments for Raynaud’s.
Raynaud’s does present a challenge to breastfeeding. However, once diagnosed it can be successfully treated. A woman can then go on to breastfeed for as long as she desires.
Anderson, J. E., Held, N., & Wright, K. (2004). Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics, 113(4), e360-e364.
Jeon, S. W., Kim, H., Jeong, M. J., & Jang, I. S. (2017). A review of acupuncture for the treatment of Raynaud's disease. The Journal of Internal Korean Medicine, 38(4), 433-442.
Barrett, M. E., Heller, M. M., Stone, H. F., & Murase, J. E. (2013). Raynaud phenomenon of the nipple in breastfeeding mothers: an underdiagnosed cause of nipple pain. JAMA dermatology, 149(3), 300-306.
Anderson, P. O. (2020). Drug Treatment of Raynaud's Phenomenon of the Nipple. Breastfeeding Medicine.
Andrea Tran RN, BSN, MA, IBCLC is a freelance writer who has been helping moms and babies breastfeed for over twenty-five years. She is married and the mother of three adult children.
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