Is deep stabbing or radiating pain between breastfeeds or white flakes on the nipple a sign of thrush?

Deep stabbing or radiating pain in the breasts between breastfeeds is awful. It's depressing actually, especially if it just goes on and on.

This kind of pain, which mightn't seem to be directly related to the breastfeeding, is not a sign of Candida or thrush, although for many years women were prescribed very long courses of antifungals if this was their experience.

However, if your baby is dragging on your nipple and breast tissue during breastfeeds because of fit and hold problems

• The skin or epithelium of your nipple is likely to become sore and inflamed. The inflammation doesn't stop just because your baby is no longer directly feeding at your breast - so your nipples hurt between feeds, too.

• Bending of your nipple during breastfeeding, or too much stretching of the nipple (which result from what scientists call 'deformational forces' or pressures), might cause bruising or microscopic bleeds in the stroma or interior tissues of your nipple. This will also result in deep pain in your breast between feeds.

The inflammation from nipple epithelial damage, and also inflammation from bending pressures on the deep tissues of your nipple, may cause

• Dull deep pain

• Sharp deep pain

• Stabbing pain that seems to radiate deeply into the breast

• A burning sensation or pain.

Women experience the pain caused by nipple and breast tissue drag, and the resulting inflammation, in many different ways, but the way you experience the pain doesn't change the diagnosis of nipple and breast tissue drag.

You can find out about the effects of mechanical forces on the nipple here.

Selected references

Douglas PS. Overdiagnosis and overtreatment of nipple and breast candidiasis: a review of the relationship between the diagnosis of mammary candidiasis and Candida albicans in breastfeeding women. Women's Health. 2021;17:17455065211031480.

Douglas PS. Re-thinking lactation-related nipple pain and damage. Women's Health. 2022;18:17455057221087865.

Jimenez E, Arroyo R, Cardenas N, Marin M, Serrano P, Fernandez L, et al. Mammary candidiasis: a medical condition without scientific evidence? PLoS One. 2017;12(7):e0181071.

Kaski K, Kvist LJ. Deep breast pain during lactaton: a case-control study in Sweden investigating the role of Candida albicans. International Breastfeeding Journal. 2018;13:21.

McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, et al. Nipple pain during breastfeeding with or without visible trauma. Journal of Human Lactation. 2012;28(4):511-521.