After I had my first baby, I was diagnosed with nipple thrush. Treatment was awkward, lengthy, and ineffective. Two years on, this is why I’ll never consider thrush a satisfying diagnosis

My experience with nipple thrush

Like so many others before me, my approach during pregnancy to breastfeeding was an ambivalent mix of “How hard can it be?” and “If it doesn’t happen for me, that’s fine – I’ve got no issues with formula.” 

As my daughter finished her first breastfeed, I saw a blood blister on one nipple and thought “Ouch! At least I have two nipples.” Two weeks on, I’d long run out of pain-free nipples to use, but found I couldn’t bear the thought of switching to formula. I’d started expressing milk in an attempt to give my cracked, raw nipples a break, but my daughter wasn’t soothed drinking from a bottle in the same way as she was at the breast. I felt like I was losing a connection with her if I gave up breastfeeding. 

On top of the painful feeds, I’d also been diagnosed with nipple thrush, which sort of made sense to me, given my yeasty predispositions as a younger adult (although to clarify, I am talking about regular vaginal thrush) and the fact I’d been on a course of antibiotics – which are known to aggravate thrush – for a week after my daughter’s birth to get rid of a strep A infection. 

I had shooting pains in my breast that got worse after feeding. I also had the pinkened skin listed as symptomatic of nipple thrush, although I was frustrated that whenever I tried to look up images of nipples with yeast infections on the internet to recognise what was going on with me, all that came up were illustrations instead of photographs. (Imagine not feeling properly represented in medical literature, even as a white person!) 

We were prescribed an antifungal cream to put on my nipples after every feed and antifungal mouth drops to give my daughter every 3 hours around the clock, a process that took forever, disrupted precious naps, and left everyone very sticky. We were told to treat parent and baby at the same time to prevent the thrush passing back and forth from nipple to mouth and back again. 

My new, expensive nursing bras had to be boiled after every wear to kill off the yeast, which destroyed their elasticity and shape almost immediately (look, I don’t hand wash my bras, but that is the recommendation – they’re delicate things). I also learned that the silver nipple cups I had been leaning on heavily to stop the constant chafing would have to be retired, as my poor leaky nipples had just been sitting in a dish of their own milk all day, creating exactly the kind of warm, moist environment that thrush thrives in. 

I used the creams; I gave the drops; I boiled my bras and towels; I sterilised my daughter’s bottle teats every time we used them. I reluctantly gave up the silver cups. Did things get better? They did not. 

My breast pain continued and my nipples were slow to heal. I bought a nipple shield and contacted an IBCLC on the recommendation of a local breastfeeding counsellor. As we waited for our appointment two days later (which felt like two months), I tried to keep one shield-free feed per day on my less damaged nipple, because I believed it was “better”. 

So what actually helped?

During our home visit, the IBCLC carried out an oral assessment on my daughter and observed a feed. As she helped me get the hang of latching my newborn onto my shielded, damaged nipple, she gave me a hopeful smile and said “I think this might work without the shield, if you want to try.” 

I didn’t really. But I took a deep breath anyway, placed my trust blindly in her care, removed the shield, and latched my daughter again with her support. And the feed went pain-free. 

Progress after this appointment wasn’t linear, as the IBCLC had warned. There were lots of good feeds and plenty of bad ones. She’d advised that we try cranio-sacral therapy to release some tension in Tulip’s tongue, and while I eyed the very light touch therapy session we attended with deep skepticism at the time, I can’t deny that feeding got better afterwards. Slowly, I stopped thinking about thrush.

I distinctly remember the first time I noticed that I actually enjoyed breastfeeding. I’d been out for lunch with my mum, leaving my daughter and a bottle of expressed milk with my husband. I can’t have been away for more than two hours, but on my way home I thought “I can’t wait for a cuddle with Tulip.” The unthinkable had happened, and I actually enjoyed feeding now that it was reliably pain-free. Nipple thrush became a distant memory.

What I know now about nipple thrush and breastfeeding pain

In the two years since having my daughter, I have learned a lot about thrush in the context of breastfeeding and chestfeeding, but I had to dig deep to find it – a lot of health authorities (including the NHS) still suggest it as a go-to diagnosis, even as they acknowledge it is overdiagnosed. 

Here are some things to know if your healthcare professional is suggesting a thrush diagnosis because you’re struggling with breast or nipple pain:

1. There’s not really any solid evidence that nipple thrush exists at all. I’m going in hard!
   
   On her excellent Makes Milk podcast, Emma Pickett (a well-respected IBCLC based in London) asked Dr Naomi Dow (another brilliant IBCLC and GP based in Aberdeen) whether she would completely dismiss it as a diagnostic possibility for breast pain. Acknowledging that while she avoids using such absolutes as “always” or “never”, Dr Dow explained that “from my perspective, there is insufficient evidence in the literature for me to consider thrush as a diagnosis for breast pain or nipple pain.” And she’s not alone in thinking this – studies are coming out that show no evidence to support the fact yeast has anything to do with breast or nipple pain. 

2. Thrush isn’t contagious. Our skin’s microbiome (and the microbiome in our gut) contains a fungus called Candida. In proportional amounts, this fungus is a healthy, normal part of us. However, given the right conditions, it can multiply too eagerly. An overgrowth of this fungus is called thrush. It’s important to know that Candida can only really multiply too quickly if the environment allows it – so if one person with excess Candida comes into contact with a second person with a healthy, balanced microbiome, that second person will not develop thrush as a result.
   
   All of this to say that if your baby is being treated for oral thrush, you don’t need to be treated for nipple thrush. And you certainly don’t need to boil your expensive bras. 

3. Thrush develops in quite specific conditions. The ideal environment for a Candida imbalance to develop is warm and moist. This means we most commonly see thrush in the genitals and the mouth. Thrush doesn’t thrive on extremities, such as the tips of your fingers or the tip of your nose. 
   
   It’s possible for thrush to develop in your internal organs, but this is a severe fungal infection. It normally occurs in people with severely compromised immune systems – such as those undergoing chemotherapy.

4. Pain during or after feeds doesn’t mean it’s thrush. A lot of symptoms attributed to nipple thrush can be explained by something else, and that includes pain during or after feeds, as I had. It is always worth having your baby’s latch checked by someone who has specifically trained in breastfeeding, as latch issues can cause a lot of trouble – the breast has so many nerves in it that nipple trauma can cause pain to be felt deep into the breast, and this can often show up as vasospasm: shooting pains caused by a temporary reduction in blood flow to the compressed nipple during a feed with a shallow latch. I had the classic lipstick-shaped nipple after feeds; my nipple often emerged white at the tip from restricted blood flow. It was worse in the cold. These were symptoms of vasospasm, not thrush, and receiving great support with my positioning and attachment helped a lot.
   
   Another cause of sharp, shooting pain is the humble but mighty bleb: a little pale-coloured dot on the nipple caused by a tiny blockage in the duct. These don’t always hurt, but when they do, the pain can take you by surprise. Don’t be tempted to pick the bleb! As a fellow picker I understand the urge. It’s not worth it and risks infection and the bleb reforming (but bigger).

4. Flaky or discoloured skin doesn’t mean it’s thrush. Flaky skin is far more likely to be caused by nipple dermatitis (heads up that this link includes many pictures of unhappy nipples), which can also be painful and itchy. Lighter skin changes to become more pink or red; brown or black skin may darken in colour or present purple or grey.  I didn’t have dermatitis, but the pinkness I saw could be easily explained by my poor generally irritated nipple feeding a baby with a shallow latch upwards of 12 times per day.
   
   Dermatitis is more common in people with a history of eczema. It can also crop up in response to lanolin usage, and can be more common in people who use breast pumps. Dermatitis tends to respond well to topical steroids.
   
   What’s that? Did you notice improvements after using an antifungal cream? Antifungals can briefly improve dermatitis-related pain in some people, thanks to their anti-inflammatory effects, but this effect is temporary and definitely not guaranteed. On the flip side, they can actually often worsen dermatitis by drying out the skin and irritating the delicate nipple further.  

5. Testing for nipple thrush isn’t very helpful at all. Low levels of Candida are often present on nipples and in mouths as part of a healthy microbiome, so it should not come as a huge surprise if any swabs carried out on your nipples show Candida growth.

6. White tongue on a baby isn’t always thrush. Sometimes it is! If they’re distressed while feeding, or have white patches on their lips, gums, tongue, or the roof of their mouth, ask your healthcare professional to take a look. But sometimes white tongue isn’t thrush, it’s just a coating of milk. This can be more common in babies with high palates, who sometimes struggle to achieve a lovely, deep latch. This can go on to cause feeding issues for them (and pain for the feeding parent, too). 

7. Silver caps can delay healing. Yes, my nipples looked pretty sorry for themselves after wearing their little silver hats 24 hours a day, but it wasn’t down to thrush. It’s common for breasts to leak in the first few weeks before your milk supply regulates, and sitting your damaged nipples constantly in a bath of their own making will only delay healing. Think of how your skin changes after a 20-minute bath and now consider soaking yourself for days. Approach with caution!

8. Antifungal use isn’t risk-free. Guidelines published by the National Institute for Health and Care Excellence recommend high or repeat doses of fluconazole are not prescribed for lactating parents.  Vasospasms can be a side effect of fluconazole – and if vasospasms were the true cause of the pain to begin with, it’s likely the antifungal will only make things worse. There’s also an increased risk of antifungal resistance (yes, much like antibiotic resistance, antifungal resistance is an emerging but serious issue). 
   
   But there’s also the quiet devastation of pinning all your hopes on something that might finally make a difference, only to get to the end of your treatment and find it’s not made a difference at all. This is precious time spent on treating a condition that in all likelihood isn’t going to get better in the time span you need it to in order to continue. And if a bad case of “thrush” that persists despite careful treatment is enough to make you give up breastfeeding before you wanted to, I think it’s worth being sure it was actually thrush to begin with.

What to do if you have breastfeeding or chestfeeding pain

I’m not going to tell you to avoid seeing your doctor if you have pain while feeding, and this is especially true if you are experiencing mastitis symptoms, which can include a swollen, painful area on the breast; skin reddening or darkening, depending on skin tone; and flu-like symptoms. 

But it is important to remember that many healthcare professionals receive very little training in breastfeeding and chestfeeding support, and the latest research on thrush may be a long while away from reaching their desks. It is always worth seeking help from someone who’s been trained in breastfeeding support to complement any medical advice you receive. 

1. Seek skilled lactation support for a latch assessment – a breastfeeding counsellor or IBCLC (look at the IBCLC directory) will be able to help you with this, although an experienced peer supporter will also be able to help optimise your positioning and attachment
2. Take notice of when the pain happens, and any other symptoms you notice. Is it during and after feeds, or just after? Is it worse in the cold? Does your nipple come out squished or white at the tip? Are there any little white or pale yellow dots on your nipples?
3. Consider other (often unexpected!) risk factors for breast or nipple pain. Could you have a lanolin allergy, or be sensitive to detergents used to wash pump parts? Do you exclusively pump? Have you taken any antibiotics recently, or any antifungals?

And of course, I’m here if you have any questions.

References

1. https://drnaomidow.com/blog/f/it%E2%80%99s-not-thrush-challenging-the-candida-narrative 
2. Makes Milk podcast with Emma Pickett (2025) Thrush and breastfeeding with Naomi Dow
3. https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/thrush/ 
4. Massie et al (2021) A picture of modern medicine: Race and visual representation in medical literature
5. Jiménez et al (2017) Mammary candidiasis: A medical condition without scientific evidence?
6. Dr Naomi Dow, breastfeeding medicine instagram
7. Breastfeeding Network: Pain: If breastfeeding hurts
8. Pearson-Glaze (2025) Blisters on nipples
9. Physician Guide to Breastfeeding: Nipple dermatitis
10. National Institute for Health and Care Excellence: Flucanozole (oral)
11. Vitiello et al (2023) Antifungal drug resistance: An emergent health threat
12. Breastfeeding Network: Mastitis information