The experience of nipple pain or tenderness in men can be a source of discomfort and concern. It is a common physical complaint that can arise from simple surface irritation to changes within the underlying tissue. Understanding the origin of the pain can help determine whether the issue is a minor annoyance or a symptom requiring professional medical evaluation. This article explores the different reasons men may experience nipple pain.
Pain Caused by External Irritation
The most frequent source of nipple pain in men is friction, a surface-level irritation caused by clothing repeatedly rubbing the skin. This is often referred to as “jogger’s nipple” or “runner’s nipple” because it commonly affects athletes engaging in prolonged, repetitive movement. The constant back-and-forth movement causes chafing, which can lead to soreness, redness, and even minor bleeding or cracking of the skin.
Another common external cause is contact dermatitis, an inflammatory reaction of the skin to a specific substance. This reaction can be triggered by irritants like harsh laundry detergents, fabric softeners, new soaps, or clothing materials. The resulting pain is typically accompanied by a rash, itching, or scaling around the nipple and areola.
Minor physical trauma, such as an accidental scratch, impact during contact sports, or excessive friction, can also cause localized pain. Extremely dry skin or exposure to cold temperatures can lead to small cracks in the nipple surface. These cracks increase sensitivity and the risk of bacteria entering the skin, potentially leading to minor infection. The pain from these external factors is usually sharp, stinging, or burning and is confined to the surface of the skin.
Pain Related to Internal Tissue Changes
When nipple pain feels like deep tenderness, aching, or throbbing beneath the surface, it often points to changes within the breast tissue. These changes are typically driven by hormonal fluctuations. The most common condition is gynecomastia, the non-cancerous enlargement of male breast tissue, resulting from a relatively high influence of estrogen compared to testosterone.
The pain in true gynecomastia is caused by the proliferation of glandular tissue, which feels like a firm, rubbery disc beneath the nipple and areola. This glandular tissue is sensitive to hormones and becomes inflamed, leading to tenderness or soreness. Gynecomastia is common during the temporary hormonal shifts of puberty, where the pain usually subsides within a year or two, and in older men as testosterone levels naturally decline.
A separate but visually similar condition is pseudogynecomastia, where the enlargement is solely due to an accumulation of fatty tissue, not glandular tissue. This condition is generally not painful. The distinction is important because true gynecomastia pain does not respond to weight loss alone, since the glandular tissue is resistant to diet and exercise changes. Certain prescription medications, including anti-androgens, heart drugs, ulcer drugs, and chemotherapy agents, can cause gynecomastia as a side effect. Rare benign masses, such as cysts or lipomas, can also cause localized aching or pressure in the tissue beneath the nipple.
Symptoms Requiring Immediate Medical Attention
While the majority of nipple pain in men is benign, certain associated symptoms act as warning signs that necessitate prompt evaluation by a healthcare provider. The primary concern is male breast cancer, which, while rare, accounts for less than 1% of all breast cancers. A persistent, hard, and fixed lump, often painless but sometimes sore, is the most frequent symptom of malignancy.
Other high-risk indicators involve visible changes to the nipple and surrounding skin. These include any spontaneous or persistent discharge from the nipple, especially if it is bloody, clear, or watery. Changes in the shape of the nipple, such as retraction or inversion (turning inward), are also concerning signs. Visible skin changes like dimpling, puckering, redness, scaling, or a rash on the nipple or areola must be evaluated.
Severe, escalating pain accompanied by systemic symptoms suggests an infection or abscess, such as male mastitis. Signs of an infection include significant warmth, rapidly increasing swelling, and intense redness over the area, sometimes accompanied by fever and chills. Any pain that is severe, lasts for more than a few weeks without an obvious cause, or occurs alongside visual changes requires a medical consultation.