Sometimes, it is natural for a nipple to become hard. In many cases, associated pain can be avoided or managed. Reasons for hard nipples include:
1. Exercise and sports
Exercise can cause nipple friction and pain.
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This is especially true for women who exercise without a sports bra, or with a poorly fitting sports bra.
This type of friction can cause soreness, dryness, irritation, and bleeding.
Long-distance runners who exercise excessively and surfers who do not wear rash guards may experience similar symptoms.
2. Allergies and sensitivities
The nipples are among the most sensitive parts of the body and will react differently to stimuli. Sensitivities to weather changes and certain fabrics, including wool, can cause pain and itching in the nipples.
Soaps, lotions, and laundry detergents can cause allergic reactions as well as itchiness. They can also cause the nipple to appear red or chapped.
3. Sexual activity
Strong and forceful friction during sexual activity, including intense oral stimulation, can cause nipples to be tender and sore. This is usually temporary and will likely resolve on its own.
4. Breast-feeding
Breast-feeding can cause a condition called mastitis, which is relatively common. Symptoms include nipple chafing and cracking, which may cause breast tissue to become infected and inflamed. Anyone who experiences this should consult a doctor for evaluation and treatment.
Applying a lanolin cream between feedings can help the skin to retain moisture. It is also a good idea to keep nipples clean and dry.
5. Thrush
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Nipple pain can be a symptom of nipple thrush, a type of candidiasis caused by Candida yeast. This is also common in people who are breast-feeding. Other symptoms include burning, stinging, cracking, and soreness.
Thrush can be transferred between the breast-feeding parent and child. Both should be treated. Breast-fed babies with thrush may have white patches in their mouths.
6. Pregnancy
Soreness and tenderness of the nipples and breasts are typical during pregnancy. This is particularly true during the first trimester, though similar symptoms may occur in the third. A well-fitting support bra can help minimize chafing, pain, and itchiness.
7. Menstrual cycle
Nipple tenderness and soreness tend to occur when levels of progesterone increase. These levels rise about a week before a period begins. Pain, sensitivity, and other symptoms will subside when hormone levels normalize.
8. Perimenopause and menopause
As women start to go through perimenopause and enter menopause, breasts and nipples can become very sore, tender, or otherwise sensitive. This is a result of shifts in hormones.
9. Birth control
Some side effects of birth control pills are similar to symptoms of pregnancy. They tend to resolve once the body becomes accustomed to the medication, which usually takes a few months. If these side effects do not resolve with time, bring them to a doctor’s attention.
10. Certain medications and herbs
Medications prescribed for depression or anxiety have been linked to pain and other symptoms in the breasts and nipples.
Some herbal remedies, including those used to promote breast milk, can also cause nipple pain, sensitivity, and tenderness.
11. Duct ectasia
Duct ectasia tends to occur most often in women close to menopause, according to the American Cancer Society. The condition is not related to breast cancer and does not increase a woman’s risk of developing cancer.
Duct ectasia occurs when a milk duct becomes enlarged and blocked, causing changes in the nipple that lead to tenderness, redness, itchiness, pain, and thick discharge.
The condition may develop into mastitis or another type of breast infection. Antibiotics may be used for management. In rare cases, blocked ducts require surgery.
12. Breast abscesses
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A breast abscess is a collection of pus in the breast and may be linked to breast-feeding or mastitis. Abscesses can also result from nipple piercings or other breaks in the skin that allow bacteria to enter breast tissue.
Breast abscesses can cause nipple pain, redness, warmth, swelling, and a fever. A healthcare professional should drain them. Small abscesses can often be drained with a needle and syringe, while larger ones require an incision.
13. Eczema
Eczema can cause itching and pain in one or both nipples. Nipples with eczema tend to look flaky, crusty and red, and discharge is possible.
This eczema can be treated with topical hydrocortisone, but before trying over-the-counter medications, see a doctor for a diagnosis. Other conditions, including cancer, can mimic eczema.
14. Reynaud’s phenomenon
Reynaud’s phenomenon is common in people who breast-feed. However, it is not caused by breast-feeding, and anyone can develop its symptoms.
In people with Reynaud’s phenomenon, the arteries that supply blood to the nipples spasm. Restricted blood flow causes numbness, burning, and pain and the skin’s color changes to white and blue. It then turns reddish when blood flow is restored.
15. Paget’s disease
Sore and tender nipples are also a symptom of a rare condition called Paget’s disease, which occurs with 1 to 4 percent of all breast cancers.
Early symptoms involving the nipple include redness and crusting. Any of the following may also be present:
- itching
- tingling
- sensitivity
- pain
- burning
- change in nipple shape
- bloody or yellow-tinged discharge
When other areas of the breast are not affected, the most common treatment involves a combination of surgery and radiation. However, chemotherapy and other treatments may be necessary, depending on the extent of associated cancer.
16. Breast cancer
Nipple pain rarely signals breast cancer, but this and other nipple symptoms can indicate the presence of the disease.
Pain, redness, scaling, thickening, and discharge from the nipple are all possible symptoms of breast cancer, according to the American Cancer Society.
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