Raynaud's of the Nipples

Q: Two weeks ago, I gave birth to my first child and she took to breastfeeding almost right away. The only problem is that after she's done feeding, my nipples are practically white in color, plus they hurt so bad it brings tears to my eyes. It's especially bad on really cold days, and since we live in Minnesota, there are a lot of those! Is there something wrong with my breasts?

Dr. Donnica: Do you ever have extremely cold fingers as well? It sounds as though you might have Raynaud's phenomenon or syndrome. This condition is an intermittent decreased blood flow to certain areas of the body (most commonly fingers or toes), but it may affect the nipples as well, particularly in nursing women. Raynaud's is nine times more prevalent in women than men. Estimates are that up to 20% of healthy women ages 21-50 may be affected. However, most women--and many physicians--are not aware that Raynaud's may affect the nipples. The good news is that this is generally treatable. Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, and the awareness of this condition is relatively low, it is often inappropriately mistaken for a yeast infection of the nipples. Symptoms may also occur during pregnancy.

Treatment options include preventing or minimizing cold exposure, avoiding substances such as vasoconstrictive drugs or nicotine, and medical therapy. Nifedipine, a calcium channel blocker (available by prescription only), has been used to treat Raynaud's phenomenon because of its prompt vasodilatory effects. Very little of the medication can be demonstrated in breast milk and thus it is believed to be safe for breastfed babies. Some lactation specialists recommend Vitamin B6 therapy (150-200 mg/day once a day for four days, followed by 25 mg/day once a day), which has shown to work in some cases after a few days, although there is no scientific evidence to support it.

Created: 11/24/2004  -  Donnica Moore, M.D.