Contents
Many women at certain times experience sore nipples. 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. Thus, sore nipples 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 this may also be a symptom of a disease. Most symptoms are not assigned an ICD 10 code. And from a medical point of view, soreness is the occurrence of discomfort and pain due to any physical influence, for example, touch, pressure or palpation by a doctor.
Causes of sore nipples
All causes of nipple pain 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, as well as luteotropic hormone produced by the pituitary gland.
Hormone-related causes of nipple soreness, manifested in women’s monthly breast discomfort and soreness in the nipple area, are a sign of natural hormonal fluctuations during the menstrual cycle (and part of premenstrual syndrome).
Sore nipples in the middle of the cycle are most often also associated with menstruation, since for many women the body begins to prepare for ovulation (the release of a mature egg from the ovary) approximately in 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 are protected from unwanted pregnancy for a long time with drugs containing hormones, then they may also experience symptoms of sore nipples.
Gynecologists explain sore nipples after ovulation by a sharp reduction in the production of estradiol and progesterone.
Pain in the nipples of varying intensity after menstruation can be both a sign of pregnancy and a symptom of fibrous formations in the mammary gland. And sore nipples during menopause are a consequence of age-related hormonal decline. 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 may include painful nipples.
Special cases of periodic painful sensations in the area of juices include women undergoing 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.
Pathogenesis of nipple pain
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, which actively work only during lactation, and the skin of the nipples is delicate and sensitive, as it is equipped with many nerve endings. Pain in the nipples during feeding is caused by cracked nipples – see the detailed article Pain in the nipples.
Painful sensations outside the period of breastfeeding can be caused by any traumatic impact – synthetic fabrics or bra seams, detergents, etc. In addition, non-hormone-dependent causes of nipple soreness include dermatological pathologies such as:
- allergic or idiopathic eczema;
- damage to the skin of the nipple by Streptococcus agalactiae and the development of streptoderma (impetigo);
- superficial candidiasis;
- herpesvirus infection localized on the nipple;
- folliculitis (inflammation of the areola hair follicles located close to the nipple).
Due to the gradual involution of the mammary glands in women of mature age, soreness in the nipple area may develop due to the expansion of the milk ducts.
The most dangerous cause of sore nipples is Paget’s disease (cancer), the symptoms 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 adolescents and young men, nipple pain when touched is hormonal in nature, and after the onset of sexual activity this condition disappears without a trace. However, if you are overweight or have diabetes, symptoms of sore nipples may persist for years.
If left untreated, non-cyclical nipple soreness can lead to complications that depend on the nature of the infection and can lead to the development of a serious inflammatory process. Its consequences can result in various types of mastopathy, which will require surgical treatment.
Diagnosis of sore nipples
Standard diagnosis of nipple soreness is based on anamnesis, physical and palpation examination of the mammary glands.
In cases of sore nipples associated with lactation, making a diagnosis does not cause difficulties, and obstetricians-gynecologists successfully cope with this task. But, taking into account the factor of hormone dependence of this condition, in other situations tests may be prescribed:
- enzyme immunoassay blood test for hormone levels;
- blood test for the presence of IgM antibodies to the herpes simplex virus;
- bacterial culture of the nipple skin for coccal infection and Candida Albicans;
Instrumental diagnostics mainly include mammographic examination (breast x-ray) and examination of the condition of the milk ducts (ductography).
If there is reason to suspect Paget’s disease, a differential diagnosis is carried out and a blood test is taken for proteins of tumor cells (tumor markers), as well as an ultrasound of the breast.
Treatment for sore nipples
A set of measures that includes the treatment of sore nipples must also include prevention. Sometimes it is enough to replace synthetic underwear with cotton ones or give up soap that irritates the skin, and the symptoms of sore nipples quickly go away.
Pain in the nipples during feeding is to combat cracks, for which doctors recommend external products 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); Actovegin gel or ointment, 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, you need ointments with antibiotics – 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 treatment is also widely used. First of all, it is recommended to apply externally an aqueous solution of propolis (heals cracks and relieve irritation), aloe juice (relieves inflammation), tea tree oil (kills bacteria), anesthetizing essential oils of geranium, sage, 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 nipple area with decoctions of chamomile, calendula and arnica flowers, St. John’s wort and celandine, white willow bark and walnut leaves (a tablespoon of dry raw material per glass of boiling water).
Among the external remedies that homeopathy offers to reduce the intensity of this symptom, it should be noted ointments based on the same calendula and St. John’s wort, comfrey root (larkspur), and internally – Natrium muriaticum (table salt).
Prevention of sore nipples
Prevention of nipple soreness is possible only in cases of non-hormonal etiology, and the main thing here is personal hygiene, the observance of which can protect against infections. And when a person takes care of his health, the prognosis is always favorable.
But if nipple soreness develops into constant pain, do not try to solve the problem yourself: the sooner you contact a specialist, the more likely it will be successfully resolved.