Does thrush infection cause breast or nipple pain when you're breastfeeding?

It used to be said that a deep, radiating or stabbing pain between breastfeeds, or a shiny pink inflamed nipple with white flakes of skin, were signs of thrush (or candida albicans) infection of the nipple. Women were given long courses of anti-fungal medications, both as ointments to apply and tablets to take. Babies were treated for weeks with oral anti-thrush medications.

In 2021 I published a systematic review which showed what I'd known for years from the research literature

• There is no evidence to suggest that lactating women suffer from candidal infections of the nipple

• Candida albicans or yeast or thrush microorganisms are commonly found in your milk microbiome, on your nipple and areola skin microbiomes, and in baby's mouth - even when there are no breastfeeding problems or nipple pain.

On rare occasions, if a woman has persistent nipple pain and there are other factors which might significantly increase her risk of a thrush infection, such as

• Recent antibiotic use

• Wearing a bra day and night

• Nipple has been kept in moist environment through use of various lotions and balms,

I might suggest a one week course of oral anti-fungal medication, just to make sure that her nipple inflammation isn't complicated by an overgrowth of candida. I don't suggest applying an anti-fungal cream or ointment to her nipples, because this can worsen moisture-associated skin damage.

You can find out about moisture-associated skin damage here.

There is also no reason to treat your baby's mouth for thrush unless your baby is diagnosed with an obvious oral thrush infection.

Recommended resources

You can read the story of Emily who has stabbing pain between breastfeeds and is wondering if this is thrush here.

Selected references

Douglas P. 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. 2021;17. doi:10.1177/17455065211031480