<It is a pinching feeling and has been known to turn the areola and nipple a dark purple even with less pressure than is required to evert the nipple.> Cathy Liles has made a good point in the use of Nipple pullers, no matter the type. This caution also applies to some types of shells with small openings. Care must be taken to observe the tissue circulation closely. Cyanosis of the nipple means too much unrelieved vacuum has been applied for too long. This is a sign of obstruction of the circulation in the nipple skin and possibly much deeper. The trapped blood changes color as it gives up its oxygen, and the occlusion has kept fresh blood from entering the capillaries. If no tenderness is noted then, it will almost certainly be noted within 24 hours. It is less traumatic to the tissues to apply less vacuum for a shorter time and progress slowly as the mother's comfort the following day dictates. I also agree with her that it can be very enlightening for an LC to try some of the paraphernalia on herself. Things are not always as simple as they might seem! Jean ********************* K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html