I don't think that there are any studies which *prove* the existence of
ductal yeast.  Yet, mothers respond clinically as if there was something
going on in the breast.  They also respond to treatment.  Call it
anecdotal experience, or just plain experience.

We know:

1. that nipple pain of a certain type seems to be due to Candida.
2. that this nipple pain responds to gentian violet, often dramatically
and little else besides Candida would respond to gentian violet
3. that this nipple pain is often associated with shooting pain in the
breast, radiating to the back or shoulder, which also responds to
treatment of the nipple pain

So there can be nipple pain, I am sure, due to Candida.  There is, at
least referred pain into the breast.

However, I have seen many women, who have only breast pain without
nipple pain, and that pain responds very dramatically, a lot of the
time, to fluconazole.  How do we explain that?  Placebo effect?  Maybe,
but I don't think so.

OB's also do a lot of things on the basis of experience, don't they.  Do
they really have evidence for a lot of things they do?  If they did,
they would not be doing routine fetal monitoring, because that has never
been shown to affect outcome of the baby or mother.

Jack Newman, MD, FRCPC