Vasospasm, when your nipple goes white and burns after a feed

This is one of the most misdiagnosed things I come across. A woman describes burning nipple pain that carries on well after the feed has finished, is told it is thrush, and is treated for weeks with creams that do nothing. When I ask what colour her nipple goes when the baby comes off, she says white, and there it is. The clue is in the colour, and almost nobody thinks to look.

What vasospasm is

The blood vessels in the nipple go into spasm and clamp down, so blood stops flowing to the tip. The nipple blanches. As the blood comes back it can turn dusky and then flush, and that return of blood is what produces the burning, throbbing or stabbing pain. It is the same mechanism as Raynaud's phenomenon, which some people get in their fingers and toes in the cold, and some women who get it in the nipple have it elsewhere too.

How to recognise it

• Your nipple loses its colour when your baby comes off the breast. On pale skin it goes white. On brown and Black skin it goes noticeably paler, greyish or ashen rather than white, and the change can be subtle.
• The pain is burning, throbbing or stabbing, and it comes after the feed rather than during it.
• It is worse in the cold, stepping out of the shower, opening the fridge, or going outside.
• It can wake you at night, or come on when you are nowhere near a feed.
• You may see the colour change in stages, pale then dusky then flushed, though not everyone gets all three and the middle stages are harder to see on darker skin. The pain and the link to cold matter more than the colour.

How it differs from thrush

Both cause burning pain after feeds, which is why they get muddled. The differences worth knowing:

• Colour. Vasospasm drains the colour from the nipple. Thrush does not.
• Temperature. Vasospasm is triggered and worsened by cold. Thrush is not.
• What helps. Warmth settles vasospasm within minutes. It does nothing for thrush.
• The baby. Thrush often comes with white patches inside your baby's mouth or a stubborn nappy rash. Vasospasm affects only you.

If antifungal treatment has not worked after a proper course, that is worth questioning rather than repeating.

What helps

• Cover up immediately. The moment your baby comes off, put your bra and top back before the air hits. Most people sit there for a minute or two, and that is the minute that sets it off.
• Dry heat, not cold. A warm hand cupped over the breast, a warm flannel, or a heat pad over your clothing. Warmth is the treatment.
• Keep your chest warm generally. Getting cold after a shower, sitting in a draught, or feeding in a cold room at night are all common triggers.
• Cut back on caffeine and nicotine if either applies, as both narrow blood vessels.
• Fix the latch. This is the big one, and it is covered below.

Why the latch usually matters

In most of the women I see, vasospasm is not happening on its own. It is being set off by the nipple being compressed and squashed during the feed. If your nipple comes out of your baby's mouth creased, flattened, wedge shaped or drawn out like a shard of glass, it has been pinched throughout the feed, and that compression is what provokes the spasm afterwards.

This is why treating vasospasm as a circulation problem alone so often fails. The warmth helps in the moment, but the trigger comes back at every feed. Fixing how your baby holds the breast is what stops it happening. If the latch will not improve with positioning changes, it is worth checking your baby's tongue, and you can read more in Tongue tie and breastfeeding and Latch and nipple pain.

When to see your GP

There is a medication that can be prescribed for severe, persistent vasospasm when other measures have not worked. It is not a first step, and it is a conversation to have with your GP alongside getting the feeding side sorted out rather than instead of it.

How a consultation helps with vasospasm

The most useful thing I can do is watch a feed and then look at your nipple the second your baby comes off, because the shape it comes out in tells us whether this is a circulation problem on its own or a compression problem causing one. Almost every time, it is the second. From there the work is practical, getting your baby deeper onto the breast and checking whether anything in their mouth is preventing that, so the trigger stops rather than being managed feed after feed. Bring a warm flannel to the appointment, and we will get you comfortable while we talk.