This lecture reviews nipple and breast pain during pregnancy and both the early and late postpartum periods. It describes the anatomy and physiology of the breast and nipple areolar complex, and explores why pain during pregnancy and lactation is so common. Specific topics include the relationship between engorgement and infant latch; pump and other nipple trauma; hypo- and hyperlactation and how pain presents in these populations; vasospasm; dermatitis; nipple blebs; and, mastitis and plugging. The lecture also covers infant considerations and defines the lack of evidence for fungal infections as a significant contributor to pain. It delineates identification and treatment of functional pain and overlap of perinatal mood and anxiety disorders with pain.
Learning Objectives:
Objective 1: Describe the complex innervation of the breast and explain why referred pain from deep in the breast to the nipple-areolar complex and reverse is so common.
Objective 2: List the most common causes of breast and nipple pain and the lack of evidence for fungal infections as a significant contributor.
Objective 3: Explain the overlap between perinatal mood and anxiety disorders and chronic pain in breastfeeding.
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