Carol b wrote, " one of the theories floating around here last year was that
pain was caused by being "fair-skinned." a more idiotic theory than most,
but extremely popular for a while. (what an insult to rational thinking, i
mean Really)."

This has been going round *here* for *years* - maybe it finally migrated its
way across the Atlantic??  But seriously, it seems to me that one reason for
nipple pain and the nipple damage that goes with it may be related to the
*elasticity* of the skin. One obvious factor which would affect the
elasticity of the areola would be engorgement.  However, even when there is
no engorgement it seems that there are some skin-types that have thicker,
inelastic breast skin, including the skin of the areola.  Red-haired women
(or very fair-haired blonde, or darker-haired, but with freckles) may be
more likely to have this type of skin whereas dark-haired (Mediterranean,
Indian, African) women may have that very fine stretchy skin that you can
almost see through.  This is not an invariable rule, of course, but I see it
often enough.

My conclusion (in the absence of ultra-sound!) is that when the skin is
inelastic the nipple is not so easily s-t-r-e-t-c-h-e-d right to the back of
the baby's throat - hence the pain, and sometimes the "chiselling" or damage
in spite of the best positioning.  When we talk about sore nipples or
latching difficulties I always feel a sense of frustration that we lump all
these things together as an end product, and I always want to *see* the
shape of the nipple and, even more importantly, the elasticity of the skin!
When I follow up these short or "tight" sore nipples from, say, birth to 2-3
weeks I often find that the nipple elongates slightly in this time
(especially with a first baby) and take it that the reduction in pain is a
consequence of the gradual elongation, rather than improved positioning,
which we all struggled to make "perfect" in the first few days, to no avail.

I have been frustrated by this for years and I remember writing to a South
African LC about it (are you out there, Nan?)  She wrote back that "really
all babies should be born with transparent cheeks so that we can see what's
happening inside!"

Pamela Morrison IBCLC, Zimbabwe