Understanding Nipple Pain: Common Causes and When to See a Doctor

Nipple pain (mastalgia localized to the nipple) has multiple etiologies:

  1. Hormonal Fluctuations: Pregnancy, lactation (poor latch, engorgement), menstrual cycle, perimenopause.
  2. Mechanical Irritation: Tight bras, rough fabrics, running (jogger's nipple), sexual activity.
  3. Infection: Bacterial (mastitis, cellulitis), fungal (candidiasis/thrush—common in breastfeeding).
  4. Dermatologic Conditions: Eczema, psoriasis, contact dermatitis, Paget's disease (rare, malignant).
  5. Systemic/Medical: Thyroid disorders, diabetes, medication side effects, breast cancer (rarely isolated nipple pain).

Red Flags (Seek Prompt Evaluation)

  • Unilateral, persistent, worsening pain
  • Nipple discharge (bloody, serous, purulent)
  • Skin changes: retraction, scaling, ulceration, erythema
  • Palpable mass
  • Associated systemic symptoms

Most nipple pain is benign and treatable. A clinical breast exam and targeted imaging (if indicated) provide reassurance or early detection.

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