Nipple Pain: Common Causes, Cyclic Patterns, and When to Seek Evaluation

Why Do Nipples Hurt?

Nipple pain (mastalgia localized to nipple-areola complex) is common and usually benign. Causes span mechanical, hormonal, infectious, and pathological.

Top Causes

Cause	Features	Management
Mechanical / Friction	Ill-fitting bra, rough fabric, running (jogger's nipple), sexual activity	Proper fit, moisture-wicking, lubricant/barrier (lanolin, nipple shields)
Hormonal (Cyclic)	Premenstrual (luteal phase), pregnancy (1st tri), perimenopause; bilateral, dull, heavy	Supportive bra, NSAIDs, evening primrose oil (mixed evidence), reassurance
Lactation-Related	Poor latch, engorgement, vasospasm (Raynaud's of nipple), bleb/milk blister	LC consult, latch correction, warm compress, nifedipine for vasospasm
Dermatologic	Eczema, contact dermatitis (detergent, soap, latex), psoriasis, Paget's (rare)	Eliminate irritants, topical steroids (low potency), biopsy if unilateral persistent
Infectious	Thrush (Candida) — burning, shiny/flaky, shooting pain; Staph — pustules, crusting	Topical/oral antifungal (mother + infant); antibiotics for bacterial
Neuropathic	Post-surgical (breast reduction, mastectomy), thoracic outlet, cervical radiculopathy	Gabapentinoids, PT, time
Malignancy	Unilateral, persistent, ± discharge, mass, skin changes, Paget's	Urgent imaging + biopsy

Red Flags (See Provider)

• Unilateral, spontaneous, bloody/serous discharge.
• Palpable mass, skin dimpling, nipple retraction.
• Pain not cyclic, not improved by conservative measures >4–6 wks.
• Associated systemic symptoms.

Self-Care

• Well-fitted, seamless, wireless bras (cotton/bamboo).
• Lanolin or hydrogel pads for friction.
• Gentle cleansing (water only; no soap on nipple).
• Track cyclicity — calendar/app.