Nipple Vasospasm (White Nipple): Symptoms, Treatment & Tips

Nipple vasospasm is characterized by tightening or constricting of the blood vessels (vasoconstriction) surrounding the nipples. It may reduce the nipple’s blood flow, which can lead to pain and a blanched appearance (whitened) of the nipples. This may often cause it to be misdiagnosed as thrush.

Nipple vasospasm is becoming a more common condition and may often only occur during or immediately after breastfeeding. The common risk factors include using a pump flange of incorrect size or having an undiagnosed tongue tie in babies. A shallow latch of the baby may also be a trigger.

Keep reading to learn the various triggers, symptoms, management methods, and preventive measures for nipple vasospasm.

Signs And Symptoms Of Nipple Vasospasm

The following signs and symptoms are often seen in nipple vasospasm (1).

• Intense nipple pain is often felt as a throbbing or burning sensation due to acute ischemia or temporary lack of blood supply to the nipples. This may worsen during cold weather.

• Nipple blanching is white discoloration of the nipple or its tip.
• Blue, red, or purple color changes of the nipple before returning to normal color after blanching (during reperfusion).

Nipple vasospasm signs and symptoms may last a few seconds or minutes in most women, while some may experience it for a longer duration. Breastfeeding support is crucial when facing breastfeeding difficulties that can arise from nipple vasospasm, resulting in a range of pain from mild discomfort to severe interference with breastfeeding.

An anonymous mom shares the experience of suffering from mastitis, nipple thrush, blebs, and nipple vasospasm during breastfeeding on her blog. She says, “Since mastitis, engorgement, cracked nipples, and thrush were not enough for one person – I also got something called vasospasm. Needle-like pain during and between feedings. I went to see yet another doctor who prescribed a new drug – fluconazole. The pain was so strong I was not able to bear anything touching my nipples, be it cloth or water (in the shower). Even silk tank tops would weigh heavy on my thrush-shredded nipples. I was topless the whole time, day or night. We banned all visitors (ⅰ).’’

Causes And Risk Factors For Nipple Vasospasm

Any condition that causes narrowing of the blood vessels or interruption of blood supply to the nipple could lead to nipple vasospasm. The following factors may trigger or increase the risk of nipple vasospasm in some breastfeeding women (2).

• Nipple damages or injuries such as cracked nipple
• Poor or improper latch
• Nipple infections such as nipple thrush or mastitis
• Certain medications
• Cigarette smoking and nicotine use

• Cold weather
• Raynaud’s phenomenon
• Autoimmune diseases
• Breast surgeries
• Low body mass index (low body weight)
• Baby has a tongue tie
• Using a pump flangeⁱXThe part of the breast pump that surrounds the nipples when it is placed on the breasts. that is too large for the nipple. This causes the areolaⁱXThe region of dark skin around the nipple on the breast.to swell around the nipple while pumping. Very few nursing mothers can actually pump with the flange size that comes with the pump. Most need to purchase a smaller flange to make pumping more comfortable and reduce the risk of nipple vasospam.

Raynaud’s phenomenonⁱXCondition that causes reduced blood flow to fingers, toes, ears, and lips, leading to color or temperature change and prickly sensation. may also cause vasospasm of the extremities (fingers and toes), which may not be associated with breastfeeding. Lactating mothers may avoid or reduce exposure to the above-listed factors. Seek support from a lactation consultant to learn proper feeding techniques and nipple care.

Prevention Of Nipple Vasospasm

The following tips may help to avoid nipple vasospasm or reduce nipple pain in some women (3).

• Avoid exposure to cold air and other triggering factors
• Use a warm pack to relieve pain
• Use an extra layer of clothing
• Use breast warmers
• Use wool breast pads
• Shower in lukewarm water

• Avoid nicotine and excess caffeine consumption
• Follow the proper breastfeeding technique to get baby in a good position with a deep latch every feeding
• Have baby assessed for tongue tie and revise the ties as needed
• Measure your nipples to find the appropriate flange size while pumping. Your flange should be approximately 2-4mm larger than the diameter of your nipple (not the areola).

If the preventive measures fail, medications and supplements are usually prescribed. You may contact your healthcare provider for a safe lactation prescription.

Treatment For Nipple Vasospasm

The following treatments may help to reduce nipple vasospasm or breastfeeding pain in some women (4).

• Acetaminophen (Tylenol) and ibuprofen (Motrin) may often be prescribed to treat lasting pain in nipple vasospasm.

• High doses of magnesium, calcium, and vitamin B6 may reduce nipple vasospasm in some women.
• Omega fatty acids may help to reduce nipple vasospasm in some women. Fish oil and evening primrose oil are rich sources of omega fatty acids.
• Nifedipine (Adalat) may be prescribed for two weeks. You may pay attention to the occurrence of side effects such as a drop in blood pressure, dizziness, flushing, and leg swelling while taking nifedipine.
• Putting a dry heat on the nipple immediately after pumping or feeding such as from a heating pad or wool nursing pad.