Breastfeeding is a skill that often requires practice and patience, and what works for one new mum may not work for another.
Many breastfeeding parents face hurdles from latch issues to mastitis, and it can be a steep learning curve for both mum and bub.
However, intense nipple pain is not a normal part of the process and there is support available if you're struggling to get started.
Seeking treatment can make a huge difference to your experience and your baby's health, so we recommend reaching out to a lactation consultant or other healthcare provider who can provide you with personalised advice.
One of the most painful conditions can be nipple vasospasm, which causes short bursts of pain during or after breastfeeding and affects around a quarter of breastfeeding people [1]. If you suspect this condition could be a factor in your breastfeeding journey, read on for all the information you need to know.
What is nipple vasospasm?
Nipple vasospasm is a condition where the blood vessels in the nipple constrict or tighten, causing pain and changes in colour.
This can happen during or after breastfeeding, making the process very difficult for some sufferers.
It is often worse during cold weather, resulting in a burning and/or throbbing sensation and the tip of the nipple turning temporarily blue, red, purple or white.
It is related to Raynaud’s phenomenon, which affects the fingers and toes in a similar way.
Raynaud’s phenomenon causes decreased blood flow to the extremities, including ears, toes, nipples, knees or nose due to spasms of blood vessels. The spasms can be in response to cold, stress, or emotional distress [2]. Nipple vasospasm is also called Raynaud's phenomenon of the nipple.
What causes nipple vasospasm?
The narrowing of the blood vessels that happens during vasospasm means blood flow is significantly slowed or blocked completely.
It is normal for some level of vasoconstriction to occur in cold weather, as the body attempts to minimise heat loss through the extremities and preserve the core temperature.
In hot weather, blood vessels naturally dilate to allow more blood to flow and heat to escape through the skin. These thermoregulatory blood vessels are controlled by the sympathetic nervous system, which explains why they can respond to emotional as well as environmental stimuli [3].
However, in people with nipple vasospasm, the blood vessels react to temperature change in a more extreme way than necessary.
Sometimes, even a slightly colder temperature, like walking into an air-conditioned room or standing in front of an open fridge, can result in severe pain. The condition can also be linked to nipple trauma or injury from the baby struggling to latch.
Are there any risk factors?
People with a family history of Raynaud's phenomenon are more likely to suffer from nipple vasospasm, as well as those who get cold fingers and toes easily or would describe themselves as having bad circulation.
Having a lower body mass index (BMI) is another risk factor, as the blood vessels of those with less body fat are often closer to the skin and therefore more exposed to temperature change.
Smokers are at risk for vasoconstriction in general due to the inflammatory effects of nicotine on the cells that line the walls of the blood vessels, so this can exaggerate the effects of vasospasm [4].
What are the symptoms of nipple vasospasm?
Sharp pain or burning that lasts for seconds or minutes, followed by throbbing as the blood returns to the nipple, is the most obvious sign of nipple vasospasm. The nipple pain usually worsens in the cold and may occur during or after a feed.
Initially, nipple blanching (turning white) is common. Then, as the blood flow returns, the nipple may darken before going back to its normal colour.
These incidents may not happen every time you breastfeed, but usually will be triggered by cold or your baby unlatching and exposing the nipple to the open air.
What does nipple vasospasm look like?
The condition is often visible to the naked eye and may look similar in colour to very cold fingers or toes.
As the blood flow to your nipple is restricted, your nipple might turn white, followed by a blueish or purple colour. Your nipples should return to their usual colour after a couple of seconds or minutes.
Does nipple vasospasm go away on its own?
Each episode of nipple vasospasm will generally only last a short time. Unfortunately, the pain will likely continue to reoccur until any nipple damage has healed.
In mild cases, warm temperatures and good attachment when breastfeeding can lead to blood vessel relaxation and stop the condition from being triggered. In more serious cases, medical treatment may be required.
If your pain level is bearable, it is possible to continue breastfeeding. Any serious nipple trauma will need time to heal, but a small amount of blood in your breast milk will not harm your baby [5].
Alternative feeding methods, like using expressed breast milk or formula, can be combined with breastfeeding if nipple vasospasm is causing you too much pain [6]. It’s completely natural to feel overwhelmed by the process, so make sure to take some time off from feeding if you need to.
Nipple vasospasm vs thrush: What's the difference?
There are a bunch of possible culprits behind pain during breastfeeding. Thrush is a fungal condition that can cause a burning, itching, stinging or aching sensation in the nipples but may not have any visible signs.
The pain from nipple thrush differs from vasospasm because it is usually ongoing, resulting in nipples that are tender and need anti-fungal treatment.
If thrush is visible, it may present as bright pink or red nipples with dry flaky skin or a white rash. It can also appear as a white coating or white spots in your baby's mouth or a red rash on their bottom.
Sometimes, a condition that was originally thought to be thrush does not clear up with anti-fungal treatment. In these cases, it may actually be a bacterial infection either on its own or in conjunction with thrush.
An antibacterial cream or oral antibiotic may be required to fully resolve the issue. Dermatitis, eczema and mastitis can also play a role in breastfeeding discomfort. As always, you should any concerns with your doctor [5].
How to get a good latch during breastfeeding
Working on the position and attachment of your baby during breastfeeding will reduce nipple trauma.
It is important that you and your little one are relaxed during the process, so make sure you have a calm environment to begin. A good latch should feel comfortable, with your baby's chest against your body and little or no areola visible outside the baby's mouth.
Baby-led breastfeeding is thought to be the easiest way to start, and skin-to-skin contact can help with getting your baby clamping properly.
When holding your baby against your chest, she or he will show signs of interest in breastfeeding when hungry. These signs can include moving the head or body and making eye contact.
When this happens, you should support the baby's head and shoulders as he or she tries to latch, rather than using your hands to help move your nipple towards her mouth [8].
A lactation consultant will be able to provide more specific recommendations, including helpful devices such as a nipple shield or feeding tube system [9].
How to treat nipple vasospasm
The simplest fix for nipple vasospasm is to keep the nipples warm whenever possible, including before and after breastfeeding, which will improve blood vessel relaxation. Breast warmers, thermals and layered clothing can help with this.
Try to minimise the time that your nipple is exposed to the open air and take care when changing or showering [10].
Kin's Breastfeeding Essentials includes an all-natural nipple cream designed to build skin elasticity, combat dryness, and prevent nipple cracking, as well as 3 sets of lightweight, bamboo breast pads that absorb moisture while cushioning sensitive areas.
The combination of these treatments can help keep your breasts warm and free from irritation.
Don't be afraid to discuss alternative feeding methods to supplement breastfeeding with your healthcare team. In serious cases, medication and/or supplements may also be prescribed.
Knowing how to recognise the signs of common breastfeeding conditions is crucial for new parents to ensure mum and baby stay healthy. Although it can be a challenging condition, don't forget that there is treatment available to support your breastfeeding journey.
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