We are intrigued with all the current discussion about breast pain and
thrush. We see many women who have breast pain, usually described as "deep,
burning, radiating pain" from the area near/around the nipple and going back
into the breast. (Any breast pain going from the breast margins towards the
nipple is likely to be due to an underlying breast condition which should be
investigated by a breast clinic.)
While we would agree that thrush can certainly be the culprit, our
interpretation of the means by which it does this is somewhat different to
other opinions we have seen so far.
The reason for this is that we have encountered as many cases of the above
type of mastalgia in women who have not the remotest likelihood of thrush
infection (as per their histories - no thrush history, no antibiotic use in
mother or baby and no use of disinfectants or hypochlorite solutions in the
months preceding) but who have babies with attachment or sucking problems.
The common factor in all of these cases is that all of the women have nipple
trauma. If the baby has thrush in its mouth, its feeding behaviour
deteriorates, presumably because of mouth irritation. We see babies who come
on and off repeatedly through feeds, fuss and often "click" as they release
breast tissue at intervals through the feed. There is not necessarily any
visible sign of white spots or patches of thrush - and it may take many
weeks before there is! This "sloppy" feeding behaviour inflicts a
pathological degree of friction and movement on mothers' nipples, hence
causing nipple trauma.
Thrush on nipples will cause damage through degradation of connective tissue
- more nipple trauma!
On the other hand, babies with attachment or sucking problems will also
cause plenty of nipple damage.

The breast pain resulting from any of these scenarios does not always begin
at feed times, but may surface well after feeds and build up to an agonising
crescendo over an hour or so between feeds. This type of pain is typical of
variously myelinated nerve fibres which transmit their messages (pain in
this case) at different speeds. This situation leads to pain cycles and a
type of pain which is not very easily relieved by ordinary analgesia. This
means that even after the underlying cause is no longer present there can
still be persisting pain until the cycle loses momentum. Wet warmth is the
best pain relief.

We feel strongly about this because of what we are observing and the success
of our approach in these cases. We'll post something about "thrush in the
ducts" on another occasion - we think it's impossible. Over to you!

Anne Bovey and Robyn Noble, Brisbane, Australia (Oz!)