Nipple pain is almost always caused by something harmless, most commonly hormonal shifts tied to your menstrual cycle, pregnancy, or puberty. That said, the cause can range widely depending on your age, sex, and circumstances, from friction during exercise to breastfeeding difficulties to, rarely, a sign of something more serious. Understanding the pattern of your pain is the fastest way to narrow down what’s going on.
Hormonal Changes Are the Most Common Cause
Fluctuations in estrogen and progesterone directly affect breast and nipple tissue, making them swell, tighten, or become hypersensitive. Your nipples are most likely to be sore in the week leading up to your period, when progesterone peaks and causes fluid retention in breast tissue. This kind of soreness is cyclical: it shows up on a predictable schedule and fades once your period starts.
Beyond your monthly cycle, several other hormonal transitions can trigger the same discomfort. Puberty, early pregnancy, perimenopause, and starting or switching hormonal birth control all cause significant hormone shifts. Pregnancy-related nipple soreness can appear within the first few weeks after conception, sometimes before you even miss a period, because of the sharp rise in estrogen and progesterone needed to support the developing pregnancy. If nipple tenderness is new and you’re of reproductive age, a pregnancy test is a reasonable first step.
Friction and Physical Irritation
Nipple skin is thin and sensitive, which makes it vulnerable to mechanical irritation. “Jogger’s nipple” is a well-known example: the repeated rubbing of fabric against nipples during running or other endurance exercise creates tiny fissures in the skin that sting, crack, and sometimes bleed. Cotton shirts are particularly notorious for this because they absorb sweat, get heavier, and cling to the chest, increasing friction. Cold weather also makes nipples more erect and therefore more exposed to rubbing.
Prevention is straightforward. A well-fitting, slightly snug shirt or a supportive sports bra reduces the back-and-forth fabric movement that causes chafing. Adhesive bandages placed directly over the nipples act as a simple barrier, and petroleum jelly or anti-chafing balms applied before exercise create a lubricating layer that keeps fabric from grinding against skin. If your pain mostly shows up after workouts or long days in rough clothing, friction is very likely the answer.
Breastfeeding-Related Nipple Pain
Some nipple discomfort is normal in the first few weeks of breastfeeding as your body adjusts, but pain that’s severe, worsening, or lasting beyond those early weeks signals a problem worth addressing.
Poor Latch or Positioning
A shallow latch is the most frequently cited cause of breastfeeding nipple pain. When a baby doesn’t take enough breast tissue into their mouth, the nipple gets compressed between the tongue and the roof of the mouth in a way it’s not designed for. This leads to cracking, blistering, and sharp pain at the start of each feed. Tongue-tie, where a baby’s tongue movement is restricted by a short or tight band of tissue underneath, can make it physically difficult for the baby to latch deeply and is found in up to about 10% of newborns. Premature babies, babies with high or low muscle tone, or those with jaw clenching habits can also cause nipple damage during feeds.
A lactation consultant can assess latch in real time and often resolve the pain within one or two sessions by adjusting positioning.
Thrush (Fungal Infection)
Thrush is a yeast overgrowth that can develop on nipples, especially during breastfeeding. The telltale signs are nipples that look pink, flaky, shiny, or cracked, with itching or burning that persists between feeds. You may also feel shooting pains deep in the breast during or after nursing. A clue that points toward thrush rather than a latch issue: nipple pain that appears after several weeks of previously pain-free breastfeeding. If your baby has white patches on the inside of their cheeks, tongue, or gums, that’s a strong indicator you’re both dealing with yeast.
Mastitis
Mastitis is a bacterial breast infection that causes a distinct combination of breast tenderness, warmth, redness, and flu-like symptoms including fever, chills, and body aches. You might notice a yellowish nipple discharge. Mastitis feels systemic in a way that simple nipple soreness doesn’t. It requires treatment, and symptoms that don’t improve within a day or two need prompt attention.
Relief for Sore Nipples
Lanolin cream is the most widely used topical treatment for cracked or fissured nipples during breastfeeding. Applying a small amount of your own breast milk to the nipple and letting it air-dry is another effective approach, thanks to its natural anti-inflammatory and antibacterial properties, though healing takes a bit longer than with other treatments. Herbal options like aloe vera and calendula have shown positive effects in smaller studies, but the evidence isn’t strong enough yet to make firm recommendations.
Nipple Pain in Men
Nipple pain in men is less common but not rare, and the most typical explanation is gynecomastia: an enlargement of breast tissue driven by an imbalance between estrogen and testosterone. More than half of male adolescents experience some degree of breast enlargement during puberty because estrogen levels temporarily rise faster than testosterone. In most cases, this resolves on its own within a year or two.
In adult men, gynecomastia can be triggered by certain medications (including some blood pressure drugs, anti-anxiety medications, and herbal supplements), as well as underlying conditions that alter hormone levels. The breast tissue often feels like a firm lump behind the nipple that’s tender to touch. If you’re a man experiencing new nipple pain or a palpable lump, it’s worth mentioning any supplements or medications you’re taking, as they may be the trigger.
Medications That Cause Nipple Pain
Hormonal contraceptives are the most obvious medication-related cause, since they directly alter estrogen and progesterone levels. But other, less intuitive drugs can also be responsible. Labetalol, a blood pressure medication sometimes used during pregnancy, has been linked to nipple pain and a condition called Raynaud’s phenomenon of the nipple, where blood vessels in the nipple constrict and cause intense pain, color changes, and burning. Symptoms typically appear 20 to 60 minutes after taking the medication and can resolve after stopping the drug. If your nipple pain started around the same time as a new medication, that timing is worth flagging with your prescriber.
Nipple Raynaud’s Phenomenon
Raynaud’s phenomenon isn’t limited to fingers and toes. The nipple’s small blood vessels can spasm in response to cold, stress, or certain medications, cutting off blood flow temporarily. The nipple turns white or blue, then flushes red as circulation returns, with burning or throbbing pain accompanying each phase. This is more common in people who already experience Raynaud’s in their hands. It can also affect breastfeeding parents, where it’s sometimes mistaken for thrush because the deep, shooting pain feels similar. The distinguishing feature is the visible color change.
When Nipple Pain Needs a Closer Look
Most nipple pain doesn’t require imaging or medical workup. If your pain follows a cyclical pattern tied to your period or has an obvious physical explanation like friction or breastfeeding, it’s overwhelmingly likely to be benign. Imaging isn’t typically recommended for cyclical or generalized breast and nipple pain.
The features that do warrant attention are pain that’s persistent, one-sided, and accompanied by visible skin changes or discharge. Paget’s disease of the breast is a rare cancer that initially looks like eczema on the nipple: itching, flaking, scaling, or a rash that may be red, crusted, or raw. It almost always affects only one breast, and symptoms may seem to come and go at first before progressively worsening. Most people with these symptoms do not have Paget’s disease, but because it closely mimics a harmless rash, any persistent, one-sided nipple rash that doesn’t respond to typical skin treatments deserves evaluation.
For focal, noncyclical pain in women 30 and older, mammography or ultrasound may be used as a first step. For women under 30, ultrasound alone is the typical starting point. The goal of imaging in these cases is primarily reassurance and ruling out a treatable underlying cause rather than investigating cancer, which rarely presents as isolated pain.