Thrush and Breastfeeding

Do you have sore nipples, or deep breast pain? Have you read somewhere or been told that this could be caused by thrush? 

This has been a common suggestion for many years. But research, and what doctors understand about how thrush behaves, is changing our understanding. (1,2,3) Experts are telling us that what we thought was thrush in the breast or nipple is much more likely to be something else. They are concerned that antifungal medications have been used to treat breastfeeding babies and mothers when they might have benefited more from a different approach. (4) 

If you are reading this and you have previously been diagnosed with and treated for nipple thrush, we recognise that this new information may feel uncomfortable to read. It might feel disappointing or frustrating to read that your experience could have gone differently, or you might feel surprised by what you’re reading. We hope that this article provides some clarity and some useful ideas. Our LLL Leaders are here to listen to your experience, feelings, and concerns if you want to talk things through.

In this piece we look at what thrush is, how it relates to breastfeeding, and other potential causes of nipple and breast pain.  

What is thrush?

Thrush is a yeast infection, usually caused by the fungus Candida albicans. (5) Candida is naturally present on our bodies and usually causes us no harm. It thrives in warm, dark, and moist environments, where it can sometimes multiply enough to cause a problem for the host – a thrush infection. Babies can get thrush in their nappy area, and women can get vaginal thrush. Both babies and adults can get oral (mouth) thrush, especially after taking certain medications, such as antibiotics or asthma inhalers. (6) Thrush doesn’t usually invade deeper tissues, though, unless the person has a weakened immune system. This means that ‘ductal thrush’ (thrush inside the breast) is very unlikely.

Symptoms in breastfeeding mothers that have often been attributed to thrush include:

• Itchy nipples.
• Flaky or shiny skin.
• Shooting, stabbing nipple and breast pain that gets worse after feeding.

However, these symptoms can all be associated with other conditions which are more likely than thrush. This is the case even if you:

• have been swabbed for thrush and had a positive result. Candida can be part of the normal healthy skin surface. 
• found some relief from using common thrush treatments on your nipples. Anti-fungal treatments have some anti-inflammatory properties and in some cases, can help relieve symptoms if inflammation is causing the pain.  

If nipple/breast thrush is unlikely, why are my nipples sore?

The NHS’s 2025 NICE guidance summarises other possible reasons for sore nipples. (7)  A breastfeeding supporter or your doctor can help you work out what might be causing the problem, and what you can do about it. Here are some of the most common causes of nipple pain.

Shallow latch 

When your baby doesn’t have a big enough mouthful of breast, the nipple is compressed during feeding. This can cause pain which is felt in the nipple and perhaps deeper within the breast, during and sometimes after feeding. A shallow latch can cause nipple damage, and if milk is not removed effectively, can lead to inflammation in the breast (mastitis).  

When your baby is deeply attached, with the nipple well back in their mouth, nursing will feel more comfortable for you, and work better for your baby.  Small adjustments to the way you hold your baby and bring them to the breast can make a big difference.  

You can read more about positioning and attachment (holding and latching your baby) here and here.

Vasospasm 

Vasospasm is a sudden narrowing of the blood vessels. The main cause of nipple vasospasm is a shallow latch. (8) If the nipple is squashed against the roof of your baby’s mouth during feeding, blood flow may be constricted.

How can you tell if your baby’s latch is shallow? 

• Feel: often described as ‘pinching’ during feeds.
• Shape:  the nipple looks pointy, like the tip of a new lipstick, when your baby lets go. You might see a ‘compression stripe’ across the end of your nipple.
• Colour: the tip of your nipple may turn paler after feeding, before going back to its usual colour. (If you have light skin, it might also turn red, blue, or purple before it goes back to its usual colour).

As blood flows back into the nipple you might feel intense pain in the nipple itself, and sometimes deeper in the breast. It’s often described as ‘shooting’ or ‘burning’ pain – a bit like the ‘pins and needles’ you feel after you sit on your foot for a long time. This vasospasm is sometimes misdiagnosed as thrush.

Tension in your body may add to deep breast or muscle pain. This deep breast pain is sometimes described as “Mammary Constriction Syndrome”, and may be relieved by massage and stretching. 

For more information, including ideas for relieving vasospasm symptoms, see Nipple Pain. 

Skin conditions

Skin conditions such as eczema, psoriasis, and dermatitis can affect any area of the body, including the nipple and breast. Dermatitis of the nipple may result in the nipple and areola (the darker coloured area around the nipple) becoming itchy, inflamed, dry, or flaky.  

Skin irritation can be triggered, or worsened, by nipple creams, including those containing lanolin, and some topical thrush treatments. (9) Skin can also become irritated from contact with breast pads, pump flanges, and other milk collection devices. 

If you have a history of skin allergies, or a similar problem elsewhere on your body, or are concerned about changes to skin on your breast or nipples, check with your GP.  Seeing a medical professional face to face may be particularly important for accurate diagnosis. A dermatology referral is sometimes necessary. Most of the treatments used for common skin conditions, including steroid creams, can be used during breastfeeding.

Mastitis

You might have heard the term ‘mastitis’ used to describe a severe breast inflammation, when you feel ill as well as having a sore breast. More accurately, mastitis means any inflammation of the breast, with or without bacterial infection. Mastitis is a spectrum, from a small, tender area without infection, to a severe breast infection. 

Different types of bacteria may be involved in breast inflammation. Some of these do not cause fever or flu-like symptoms, but you may still experience painful breastfeeding, needle-like burning pain, or engorgement. Some researchers have suggested the term ‘subacute’ or ‘subclinical’ mastitis to describe inflammation of the breast without fever or flu-like symptoms. These researchers believe that the term ‘mammary candidiasis’ (thrush) should be avoided and replaced by ‘subacute mastitis’, though this is disputed. (10) 

You can read more about mastitis here.

Bacterial infection 

Bacterial infections of the nipple can cause symptoms such as burning pain and soreness. If your nipple is infected you might see:

• yellow discharge or pus,
• crustiness,
• nipple swelling,
• colour change, or
• nipple cracks which don’t heal.

An infected nipple is likely to be painful all the time, not just when breastfeeding. You’ll probably have had recent nipple damage, perhaps in the early days of breastfeeding, or from an older baby who is teething or experimenting (ouch!). Staphylococcus aureus (Staph. A) is the most common bacterium associated with nipple infection and can be treated with antibiotics. Contact your GP if you think you might have an infection. (11)

Milk blister/Nipple bleb 

Milk blisters (also known as blebs) look like tiny white or yellow dots on the tip of the nipple. They haven’t been studied much, and we don’t really know why they form. Milk blisters that don’t block milk coming out, and don’t hurt, can be safely left alone. They eventually disappear.  

Sometimes, though, a milk blister is extremely painful (often described as ‘stinging’ pain). Sometimes they form in one or more ‘milk pores’, blocking milk from coming out of part of the breast. The Academy of Breastfeeding Medicine Mastitis Protocol has some suggestions for treating troublesome blebs. (12)

You can find more information in our article on nipple pain.

  For more information see Further Reading.  

Pain caused by pumping

If you are pumping, it is important that your pump flange fits you comfortably, and that the pump suction isn’t turned up too high. A poorly fitting pump flange, or too-high suction, can cause nipple pain and damage. You can read more about pump fit in our article on nipple pain.

Neuropathic pain

Experts have recently suggested that some pain experienced in the breast may be “neuropathic” pain. Neuropathic pain is connected to how the nerves function in the body.  According to the NHS website, “Unlike most other types of pain, neuropathic pain does not usually get better with common painkillers, such as paracetamol and ibuprofen, and other medicines are often used.” (13). Some types of antidepressant medication may be effective at reducing or eliminating this type of pain. (14,15) If you think you may be experiencing neuropathic pain, talk to your GP. 

If none of these conditions seem to fit your situation, you can find more information in our article on nipple pain. LLL Leaders are available to help – you can find all our support services here.

I think my baby has thrush – what do I need to know? 

Signs of thrush in your baby may include:

• White patches inside their cheeks, on their tongue, roof of mouth, or gums. When wiped off they may look red or bleed.
• Fussing during and between feeds, due to discomfort.
• Nappy rash that doesn’t improve when you use a barrier cream.

A white coating on the tongue alone is not a sign of thrush, as many babies have a white, milky coating on their tongue. Nappy rash and fussiness may also have other causes. If you think your baby may have thrush, contact your doctor. 

If your baby is diagnosed with thrush, you can carry on breastfeeding as normal.

Medication for oral (mouth) thrush is usually applied to the baby’s mouth four times in 24 hours, after feeds. Your baby may be prescribed: 

• Miconazole oral gel. Manufacturers recommend that this is not used in babies under four months old due to risk of choking. Healthcare providers must ensure that the parent/carer is aware of how to apply the gel safely if prescribed under this age.
• Nystatin oral suspension. This is considered less effective than miconazole gel, but can be used in young babies. (16)
• Antifungal nappy cream, if they have thrush in the nappy area.

Do I need to take special hygiene precautions?

It used to be recommended that when a baby had thrush in their mouth, the mother’s nipples were treated with antifungal cream, and everything that touched the baby’s mouth, or milk, was carefully sterilised. This is probably unnecessary. According to the website Physician Guide to Breastfeeding: 

“When infants undergo thrush treatment, mothers do not need to undergo antifungal treatment themselves.  Pump parts, infant toys, and other household items do not need to be sterilized”. (17) 

Previously, mothers were advised to avoid expressing and storing milk during a thrush (yeast) infection. However, there is no evidence to suggest that this is necessary. The Academy of Breastfeeding Medicine Clinical Protocol #8 (Human Milk Storage Information) says:

 “If a mother has breast or nipple pain from a bacterial or yeast infection, there is no evidence that her stored expressed milk needs to be discarded”. (18)

What if I have vaginal thrush?

Vaginal thrush is very common. It may be more likely if you’ve recently taken antibiotics.  It can be itchy and uncomfortable, but it’s usually harmless. Vaginal thrush can be treated with over the counter medication, which is safe to use while breastfeeding. 

See Further Reading for more information.

Summary

There are many causes of nipple and breast pain, and while historically, nipple and breast thrush has often been thought to be a possible cause, there is growing consensus that this is very unlikely. There are other more likely causes of persistent nipple and breast pain that should be investigated first. (19, 20) Vaginal thrush, thrush in the nappy area, or oral (mouth) thrush can be treated without interrupting breastfeeding.

Written by Nicola Coles-Carr, Polly Smith, Sharon Tierney, and Jayne Joyce, May 2025

Copyright LLLGB May 2025

Further Reading

References 

1. Jiménez, Esther et al. “Mammary candidiasis: A medical condition without scientific evidence?.” PloS one vol. 12,7 e0181071 (2017). doi:10.1371/journal.pone.0181071 https://eadn-wc01-5994650.nxedge.io/wp-content/uploads/2021/08/JimenezetalCandidiasnotcauseofpain.pdf  
2. Betts, Ryan Colton et al. “It’s Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain.” Breastfeeding medicine: the official journal of the Academy of Breastfeeding Medicine vol. 16,4 (2021): 318-324. doi:10.1089/bfm.2020.0160  https://eadn-wc01-5994650.nxedge.io/wp-content/uploads/2k021/08/ItsnotYeast.pdf 
3. Plachouri, Kerasia-Maria et al. “Nipple candidiasis and painful lactation: an updated overview.” Postepy dermatologii i alergologii vol. 39,4 (2022): 651-655. doi:10.5114/ada.2022.116837 https://www.termedia.pl/Nipple-candidiasis-and-painful-lactation-an-updated-overview,7,47192,0,1.html
4. Douglas, Pamela. “Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women.” Women’s health (London, England) vol. 17 (2021): 17455065211031480. doi:10.1177/17455065211031480 (accessed March 2025) https://eadn-wc01-5994650.nxedge.io/wp-content/uploads/2021/08/douglasmammarycandidiasis2021.pdf
5. https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/thrush/
6. https://www.nhs.uk/conditions/oral-thrush-mouth-thrush/
7. National Institute for Health and Care Excellence, Breastfeeding problems: How should I diagnose the cause of nipple pain?, Feb 2025 (accessed March 2025) https://cks.nice.org.uk/topics/breastfeeding-problems/diagnosis/diagnosis-of-nipple-pain/
8. Deniz, Serap, and Bahar Kural. “Nipple Vasospasm of Nursing Mothers.” Breastfeeding medicine: the official journal of the Academy of Breastfeeding Medicine vol. 18,6 (2023): 494-498. doi:10.1089/bfm.2023.0024 (accessed April 2025) https://www.liebertpub.com/doi/10.1089/bfm.2023.0024?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
9. https://www.nhs.uk/medicines/clotrimazole-for-thrush/side-effects-of-clotrimazole-for-thrush/
10. Douglas, Pamela. “Re-thinking benign inflammation of the lactating breast: Classification, prevention, and management.” Women’s health (London, England) vol. 18 (2022): 17455057221091349. doi:10.1177/17455057221091349 https://pmc.ncbi.nlm.nih.gov/articles/PMC9024158/ 
11. https://cks.nice.org.uk/topics/breastfeeding-problems/diagnosis/diagnosis-of-nipple-pain/
12. Mitchell, Katrina B et al. “Academy of Breastfeeding Medicine, Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.” Breastfeeding Medicine vol. 17,5 (2022). doi: 10.1089/bfm.2022.29207.kbm 
13. https://www.nhs.uk/conditions/peripheral-neuropathy/treatment/ (accessed March 2025)
14. http://www.breastfeeding-and-medication.co.uk/wp-content/uploads/2018/09/neuropathic-pain-and-breastfeeding.pdf
15. Urits, Ivan et al. “Off-label Antidepressant Use for Treatment and Management of Chronic Pain: Evolving Understanding and Comprehensive Review.” Current pain and headache reports vol. 23,9 (2019): 66. doi:10.1007/s11916-019-0803-z (accessed March 2025) https://eadn-wc01-5994650.nxedge.io/wp-content/uploads/2021/08/Urits2019_Article_Off-labelAntidepressantUseForT.pdf 
16. The Breastfeeding Network Drugs in Breastmilk Information. Miconazole Gel and the Breastfed baby with Oral Thrush (Candida), May 2020 (accessed March 2025) https://www.breastfeedingnetwork.org.uk/factsheet/miconazole/
17. https://physicianguidetobreastfeeding.org/mythbusters/yeast/ (accessed March 2025)
18. Eglash A et al. “ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, Revised 2017.” Breastfeeding Medicine vol.12,6 (2017). doi: 10.1089/bfm.2017.29047.aje
19. National Institute for Health and Care Excellence, Breastfeeding problems: What are the causes of nipple pain?, Feb 2025 (accessed March 2025) https://cks.nice.org.uk/topics/breastfeeding-problems/background-information/causes-of-nipple-pain/ 
20. Amir, Lisa H et al. “Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia.” BMJ open vol. 3,3 e002351 (2013). doi:10.1136/bmjopen-2012-002351