Hi Christine,
You asked, "What things could cause this kind of soreness after months of
good breastfeeding?"  The most likely would certainly be yeast, and it is
most probable that this is a case of unresolved yeast.  Culture results can
be inconclusive, so "testing" for yeast is not always effective.  Examining
the nipples doesn't necessarily tell you anything.  Women can have redness,
cracking, blisters, and/or bleeding...but they also may have nipples that
look normal.  I think the most important thing is what she is telling you.
When a woman says that the pain has become "unbearable," most of the time it
turns out to be yeast.  This mother said her nipple looked as if it had been
burned.  That is a common finding with yeast.  You said she was treated.  How
and for how long?  Many women think they have been treated for yeast, but the
treatment may be what we now know to be inadequate (i.e. 5 days of diflucan).
 Was the baby treated as well?  It doesn't matter if the baby is
asymptomatic, BOTH need to be treated in order to resolve the problem.  You
mentioned ointments.  You do not need to find the cause if you use Dr. Jack's
APNO (All Purpose Nipple Ointment).    Dr. Jack's information on using
gentian violet, diflucan, and (APNO) is available at either of the following
websites:     <A HREF="http://www.erols.com/cindyrn/drjack0.htm">Jack Newmans Articles</A>      <A HREF="http://www.bflrc.com/jn/jn_arts.htm">Dr. Newman's Pages</A>
Cher Sealy, RN, BSN, IBCLC
The Breastfeeding Encounter
Montgomery, AL

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