Feeling pain or itching in the nipple is a rather common event and, as such, it is not usually an indication of a pathological process but rather a simple passing phenomenon that should not arouse fear and anxiety.
The nipple is a delicate and very sensitive area of ​​the body due to the strong vascularization and the dense network of nerve endings that reach it, therefore even a small stimulation is easily perceived.
At the same time a pain in the breastor to its skin appendages, in the most anxious subjects it can cause particular concern because it immediately leads the symptom back to the possibility of a tumor, exacerbating the painful sensation even when it is minimal.
That said, it is certainly useful to say that breast cancer is not a rare occurrence, indeed, due to its spread in the population it is always recommended to undergo periodic screening checks (mammography). However, at the same time it is necessary to reassure in order to avoid unnecessary fear and preventive alarmism without diagnostic foundations.
In fact in most cases the pain in the nippleit is caused by physiological changes in the mammary gland or by a small trauma or by rubbing with tissues or irritants that can cause more itching than real pain.
Sometimes, however, the pain in the nipples can represent a real alarm bell for a disease of a more serious entity that requires adequate therapies. The speech is valid for both men and women.
Before going on to deepen the problem, it is useful to provide some hints of anatomy in order to illustrate the structure of the nipple and to better understand the possible causes that can be hidden at the origin of the pain, and therefore the close connection with the mammary gland.

How the nipple is made
The term nipple refers to the protruding part of the breast. It has a conical shape, a darker color than the skin of the breast and is surrounded by a circular area called the areola.
On the surface of the areola there are small protrusions that constitute the outlet of the sebaceous glands, called tubercles of Morgagni, while in the protruding part of the nipple there are about 20 small holes that constitute the outlet of the mammary gland.
The mammary gland is therefore located in the area inside the nipple and breast, and is responsible for the production of breast milk which is drained outside during the lactation phase towards the excretory ducts located in the nipple.
Furthermore, the mammary gland is strongly influenced by the hormonal levels of estrogen and progesterone, therefore its size varies several times and cyclically throughout the woman’s life.
The gland increases in size during puberty, becomes hypertrophic in conjunction with ovulation and the menstrual cycle , increases in size during breastfeeding and loses volume and tone during menopause.
Having said that, let’s see when it is appropriate to seek medical advice in the case of nipple pain .

When to seek medical attention
If nipple painit resolves in a few days and if it occurs cyclically in conjunction with ovulation or the menstrual cycle there is nothing to worry about as it is a completely normal event to be associated with the hormonal cycles to which the woman is subjected monthly.
If, on the other hand, the pain is persistent and is accompanied by manifestations such as redness, cracks, secretions, the presence of swellings, lesions, changes in the color and shape of the nipple , it is necessary to contact your doctor promptly. He will then be the one to guide you towards more appropriate specialist visits .
It is strongly recommended not to rely on the advice of alternative therapies found on the web, in the same way it is not recommended to improvise self-medication: the only right path to follow for a correct diagnosis and therapy is exclusively the medical one.
Let’s now analyze the main causes behind the appearance of persistent nipple pain .

What are the causes of nipple pain
The causes of nipple pain in most cases are of a physiological nature, therefore temporary, cyclical and without negative results. Sometimes, they can be of a traumatic nature and more rarely they can have pathological implications worthy of clinical investigations and specific therapies.
Let’s go, therefore, to provide an overview of the main causes of nipple pain .

Non-pathological causes

  • Hormonal : alterations in hormonal values ​​are at the origin of most of the phenomena of pain in the nipple . This type of occurrence occurs during the various phases of the menstrual cycle, as a consequence of pregnancy and at the time of menopause. Therefore, these are physiological and often cyclical causes, which do not represent any risk and for this reason there is no reason to worry. During ovulation and the menstrual cycle, the mammary gland becomes hypertrophic, therefore it enlarges and there is a greater flow of blood. The result is greater localized sensitivity and therefore pain in the nipple . A similar situation is also found during pregnancy and during menopause.
    Hormonal alterations can also affect the breast and nipple in males , especially during puberty, a period in which the breast may experience pain and swelling but which generally pass spontaneously with growth;
  • Breastfeeding : during the breastfeeding period, pain may occur due to the pressure exerted by the milk produced by the mammary gland on the nipple. The gland increases in volume and it is very common to feel a sensation of tension that is localized at the level of the nipple but also extends to the whole breast. After feeding, the pressure is reduced and the pain passes.
    During the breastfeeding phase, especially when the baby’s first teeth come out, it is very frequent that the friction of the teeth on a tissue as delicate as that of the nipple, gives rise to lesions ( fissures ) and, given the sensitivity and ‘nipple innervation seen above, it is understandable why they cause severe pain;
  • Rubbing : this kind of occurrence is as common in the female gender as in the male one . As stated several times, the nipple is a very delicate tissue and contact with rough tissues or irritants immediately cause pain, redness and cracking of the skin. There is also a characteristic pain in the nipple in those who practice sports, in fact, the tissues tend to create constant friction with the nipple, causing discomfort and pain from rubbing.

Pathological causes
These are rarer cases for which, however, careful treatment by a specialized doctor is necessary.

  • Infections: in these cases, in addition to the pain felt in the nipple , there are also fever, a feeling of tension in the breast and sometimes the appearance of secretions. An infection can commonly be the result of an injury or cut. We have previously seen how breastfeeding women are subject to nipple lesions which are called fissures, and this lesion, if not properly treated, can result in an infection;
  • Cancer: one of the most feared causes, but it must be pointed out that there are benign and malignant forms and that today, thanks to the screening campaigns and the effectiveness of the therapies, survival is very high.
    One of the most aggressive forms to keep an eye on is breast cancer which results in a series of symptoms and signs that take the name of Paget’s disease . How it manifests itself
    The manifestation is quite obvious, resulting in a painful swelling of the nipple with dry skin, pain, redness, secretions, a burning sensation and itching and also alterations in the shape of the nipple that can take on an inward or outward appearance. Generally, in the case of cancer, the signs and symptoms manifest themselves in only one of the nipples and in these cases it is advisable to undergo a medical check-up as quickly as possible.

Let us now analyze in detail the main diagnostic techniques we have available.

How to make the diagnosis
Regardless of the presence or absence of pain or alterations in the nipple, it is recommended to carry out a monthly self-examination of the breast, in the period following menstruation. This is because the gland deflates from the typical turgor present in conjunction with the menstrual cycle. If during the self-examination you notice any changes and it is necessary to seek medical attention.
That said, the periodic check-up and diagnosis of any complaints felt are the sole responsibility of a doctor, who carries out all the necessary checks to exclude serious breast and nipple diseases.
The doctor checks if the problem is present only in one breast, therefore unilateral, or if it occurs both in the right breast and in the left breast , therefore bilateral. And it is of great importance to ascertain whether there are particular pathologies in the patient’s family and whether he suffers from any disease and takes particular drugs.
It is also important to evaluate all those signs and symptoms that are associated with pain in the nipples , therefore the presence of pain, fever, redness, changes in the shape of the areola, the presence of nodules, color variations and if the nipple appears inverted. or everted.
The presence of secretions leaking from the nipple during a squeezing maneuver provides important information to the doctor, directing the diagnosis.
If the secretions are transparent and limpid, they usually do not arouse any suspicion, if instead they are of a milky appearance the hypothesis towards which we are oriented is hyperprolactinemia (due to high levels of prolactin hormone), for which we proceed with an examination blood to confirm the suspicion or not.
Sometimes the secretions can be green in color, and are usually the consequence of an infectious process, while if the secretions are dark, red or brown, the diagnostic suspicion is oriented towards tumor causes.
The diagnosis can then use instrumental diagnostic means, such as ultrasound to have a clearer view of the tissues and the mammary gland, checking for the presence of any nodules.
What does the therapy consist of?

What are the therapies in these cases ?
The therapy for nipple pain adapts to the phenomenon that caused it and in any case must be prescribed by a specialist doctor after having carried out all the necessary investigations.
In case of irritation from rubbing or small lesions, the use of nipple covers and less adherent clothes is recommended, if instead wounds are also associated, such as fissures, soothing creams for pain or anti-inflammatory creams are often administered.
Furthermore, for women who are breastfeeding, it is important to follow the correct procedures for cleaning the nipple before and after feeding and to facilitate the taking of the nipple in the mouth by the baby, reducing traumatic episodes during latching to the breast.
As for the other causes, those of pathological origin, the therapy will focus on the pathological process at the origin of the manifestations of pain in the nipple .
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