Jahaan, (and Fran) For what it's worth, this is my $.02 worth. I think this is something to keep in mind as you read your e-mail answers and/or read the excellent sources in the LLL publications, various nursing, medical and lactation consultant journals and books, older and newer. The dictionary offers different definitions for the word "sore". As an adjective, it means "tender". As a noun, it means "wound". This grammatical distinction gets forgotten or ignored in everyday conversation, especially if the remark originates with the mother. She knows no other word to use, and has no basis for knowing how to say, "There is only tenderness, but no wound." or "There is a wound, as well as tenderness." It is up to the HCP to look at, and sometimes, to palpate in order to assess the source(s) of the pain, and this is seldom done until it almost seems like an emergencey to the mom. Over the years, I have seen mothers with very tender nipples without visible damage given advice for wound healing. This is especially prevalent in phone counseling, but also in the hospital when the doctor may hurry into the room, ask how she's feeling, hear her say "sore" nipples, prescribe a proprietary cream and hurry on out of the room to the next mom. Too many HCP's, even in the "hands-on" professions, with the privacy to make a thorough assessment, prefer to judge this symptom and attempt to solve this problem solely on the basis of words, rather than have the mother drop her flaps and INSPECT and (heaven forbid) perhaps PALPATE the nipple-areolar complex. It is also possible for a mom without skin damage to have a very painful latch in the early days which is caused mainly by overfull milk reservoirs. When compressed, vigorously and suddenly as in latching, the overstretched walls are PAINFUL, but since it seems to be coming from the outer central area of the breast, everyone assumes it must be from the nipple button. Gentle manual extraction of 4-5 drops in opposing quadrants of the areola can markedly reduce or totally eliminate early latch pain, soften the subareolar tissue and help the jaws stay deep enough on the breast to extend the nipple back nearer the soft palate. This can often decrease the chance of nipple trauma and subsequent pain and/or damage. It is easily taught to most mothers. It is possible for a mom with visible damage of the skin to have very little pain in the nipples. I have seen mothers who make ME wince when I look at their nipples, casually latch on and describe a "tug" or maybe a momentary 30 second discomfort. There is an excellent article cited in the March '99 JHL by Brent, et al, in Archives of Pediatric and Adolescent Medicine, Nov. 98, that states there is no correlation between the appearance of the nipple and the severity of the pain the mother describes. I agree totally. Better assessment of the nipple areolar complex for the precise tissue level(s) in which the mother is feeling the discomfort would be a better foundation for intervention for many moms. So when you receive answers to your query, unless you are being specific about descriptions about the meaning of "sore" in that particular case, I think it might be about like the fable of the blind men trying to describe an elephant. Every one sees one part of the picture, and thinks his definition (and treatment) is "the solution." Using the term "sore", especially if you are taking the mother's subjective complaint as the basis, is sort of like talking about fruit salad. I could be talking about oranges and bananas while you might be visualizing strawberries and peaches etc. Unfortunately, reading the published literature, not just the older "research", but even a lot of more recent studies, use the term "sore" in a very generalized, non descriptive way, and may be using it to describe different meanings, some meaning for instance, "extreme tenderness without visible damage" and sometimes meaning "actual visible damage that is not especially tender", or any variation as individual as the mother perceiving it. For my money, some highly touted and oft-quoted research conclusions are without value to me because their terms are imprecise and nonspecific. It is as if a medical article were to be written in this day and age about treatments for "bellyache". No use of the term rebound tenderness, or colic, or which quadrant, or whether in the suprapubic area or whether constant or sporadic, or whether accompanied by frequency and painful voiding or diarrhea, etc., etc. And no palpation of the abdomen, and certainly no mention of the patient's perception of the severity of the pain on a scale of 0-10. Just call it a bellyache and give 'em calomel! To sum up briefly, sources of nipple discomfort can be different at various stages of lactation. Discomfort can come from trauma to the nipple button and/or nerve compression without visible damage, from early overfull milk reservoirs, as well as skin damage, which could be uninfected, or sooner or later infected with yeast, or infected with various sorts of bacterial organisms, and sometimes from a combination of both. And for some moms who have used the word "sore", they get relief from any kind of treatment because of the placebo effect. The nipples were due to get over their pain or wound sooner or later anyway, but right now, they hurt. If someone can reassure her she's going to be alright and give her a method of "doing something", anything, including "getting a good latch" (another term that could stand better definition), while she waits for it to happen, she will associate it with having "cleared up her sore nipples." I had a sister-in-law who 35 years ago was told to put distilled vinegar on her nipples after every feeding to "toughen" them, and lo and behold, they got better! K. Jean Cotterman RNC, IBCLC Dayton, Ohio ___________________________________________________________________ Get the Internet just the way you want it. Free software, free e-mail, and free Internet access for a month! 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