Nipple problems

Nipple discharge
Nipple discharge is usually harmless and does not signify anything seriously wrong. In fact, most women can squeeze some discharge out of their nipples, especially if they have had children in the past. This may be whitish or may be yellow-green or almost black.

On the other hand, nipple discharge can be a symptom of breast cancer, particularly if it is bloodstained. Therefore, you should definitely discuss any nipple discharge with your doctor. If you are a man, you should see your doctor straight away, because the usual cause is a tumour and you will need treatment.

What your doctor will do. Your doctor will check your medication, because some drugs can cause (non-bloody) nipple discharge. The most common culprits are:

• cimetidine (for stomach problems)
• oral contraceptives
• some antidepressants and other drugs for psychological problems
• domperidone (for nausea).

Your doctor will ask whether there is any possibility that you could be pregnant. Some women have nipple discharge very early in pregnancy. Your doctor will then examine your whole breast thoroughly (not just the nipple), to make sure you have no lumps.

Even if you have not noticed any blood, your doctor may ask you to try to squeeze a few drops out, and will test it for microscopic blood.

Each nipple has about 15–20 tiny pores on it. These pores are the openings of ducts that connect with the glandular tissue in the breast. You and your doctor should try to work out whether the discharge is coming from just one pore, or from several.

• The cause is very, very unlikely to be breast cancer if the discharge is coming from several pores, it does not contain any blood and you are under 50 years of age.
• If the discharge is bloodstained, or it is emerging from just one pore, your doctor will refer you to a hospital clinic for tests (such as ultrasound, mammography and looking at the discharge under the microscope) to make sure that breast cancer is not responsible.
• If the discharge is milky and coming from both breasts, your doctor can do a blood test to check for an imbalance of the hormone prolactin.

If all the tests are normal, you can stop worrying, but the discharge may still bother you (perhaps soiling your clothes). A possible cause is some inflammation (mastitis) around the ducts. This is linked with smoking, and may improve if you stop smoking and avoid squeezing. A course of antibiotics may help.

It is possible to have an operation to close or remove the ducts that the discharge is coming from. This operation may not be a good idea for anyone who plans to become pregnant afterwards – depending on the number of ducts involved, it might make breastfeeding difficult and the breast might become congested.

For more information about the breast, look at the section on breast problems

Inverted nipples
Most women’s nipples protrude (stick out) about 5–10 mm. Usually they become about 10 mm longer and 2–3 mm wider during sexual arousal. Some women have nipples that are flat, but become erect during sexual arousal or when a baby is sucking on the nipple. Nipples that are tucked into the breast, instead of being flat or sticking out, are called inverted nipples. Both nipples may be inverted, or just one.

Nipples that have always been inverted. If your nipples have been inverted for as long as you can remember, it is nothing to worry about. It is just the way you are, and a lot of women are the same. A survey of 3000 women attending an antenatal clinic found that 10% had inverted nipples.

A nipple that suddenly becomes inverted can be a sign of a cancer underneath it, so you should see your doctor straight away.

Breastfeeding should not be too much of a problem if your nipples become erect in the cold or when you are sexually aroused. It will be harder for the baby to draw the nipple into the back of its mouth, so breastfeeding will require some patience, but eventually the baby’s strong sucking will draw the nipple out. You will be able to help by applying an ice cube wrapped in a flannel to the nipple beforehand and by stroking the areola (the pink area round the nipple).

If stimulation does not make the nipple protrude, breastfeeding may be more difficult. During the last 6–8 weeks of pregnancy, you may be able to encourage the nipples to stick out by wearing breast shields under your bra. These are small devices that press gently on the breast around the nipple. They are quite comfortable. They are worn for 1 or 2 hours at first, and the time is gradually increased. Your midwife will be able to advise you.

Ways of making your nipples protrude. Even if you do not intend to breastfeed you may wish to have protruding nipples. Teenagers often have flat nipples and, in some women (especially if their periods did not start until late), they remain flat until the early 20s. So if you are young, there is a possibility that they may gradually start to protrude. Otherwise, you could try stroking the areola with warm hands for a few minutes each day to bring the nipple out. You could also try wearing breast shields. Do not wear them for too long at first, otherwise the breasts may become sore, and do not continue wearing them for more than 6 weeks.

If these measures do not work and your nipples are really distressing you, it is possible to have a small operation to make the nipples protrude. This involves a small incision on each side of the nipple, and the cutting of some ducts and tissue. The drawback is that some women cannot breastfeed after this operation, and the operation is very expensive (and not available on the National Health Service).

Hairy nipples
Coarse, dark hairs around the nipple are quite common. You can pull them out with tweezers, but this can cause irritation because the skin round the nipple is very sensitive. It is probably better simply to cut them off close to the skin. This is easier if you hold the end of the hair with tweezers to keep it taut. The hairs will grow again, so you will have to cut them off again from time to time.

Hairs round the nipple are nothing to worry about unless you have excess hairiness on other parts of the body and your periods are irregular. If this is the case, you may have polycystic ovary syndrome (PCOS) and you should see your doctor. You will find more information about PCOS in the section on hairiness in women.

Itchy, scaly nipples
If your nipples are itchy, scaly and cracked, you probably have eczema. The itching can make this an embarrassing condition. It occurs mainly in women in their late teens, and usually affects both nipples. It may be only on the nipple, or may affect the flatter area surrounding the nipple (the areola). A steroid cream from your doctor will deal with it. Your doctor will check that it is not scabies, which can cause a similar appearance.

‘Jogger’s nipple’ is another possibility. This is caused by friction from clothing, especially during long-distance running. Protect your nipples with petroleum jelly (Vaseline) or surgical tape (Micropore, from pharmacies) before exercising. A silk running vest is less abrasive than synthetic fibres.

Very rarely, eczema of a nipple can signal a cancerous growth beneath. This is uncommon, but it is why you should see your doctor if you have eczema on only one nipple. It occurs mainly in middle-aged or elderly women. It is not usually itchy, but there may be a pricking or burning feeling.

Extra nipples
Most people have only two nipples, but about 1 in 50 people (both males and females) has more. These extra nipples are not as well formed as the main nipples, so you may have them without realizing what they are. Imagine a line drawn between the armpit and the inner thigh; the extra nipples are usually on this line.

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