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Feelings of sadness or dread when your nipples are touched may be linked to dysphoric milk ejection reflex (D-MER)
Social media has a knack for building communities around shared experiences. That’s the case with sad nipple syndrome. People online describe it as intense negative feelings when their nipples are touched.
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Medically speaking, sad nipple syndrome isn’t an official diagnosis, and little is known about it. But it may be related to a similar condition that occurs during breastfeeding.
Here’s what we know — and don’t know — about this phenomenon and what to do if your nipples are making you feel blue.
Sad nipple syndrome is an emotional reaction triggered by sexual or nonsexual nipple stimulation. For some, all it takes to bring on the reaction is the light touch of a bra or shirt.
Although sad nipple syndrome can affect anyone, it seems more common in women.
Those who experience sad nipple syndrome report a wide range of strong emotions, which typically pass within a minute or two. Some feel sadness, discomfort or even impending doom. Others feel:
There are no studies on sad nipple syndrome. So, healthcare providers aren’t sure how or why it happens. But that doesn’t mean this isn’t a real problem. In fact, psychiatric mental health nurse practitioner and women’s behavioral health specialist Maureen Sweeney, PMHNP, says more research is needed to determine the cause as healthcare providers begin to dive deeper into women’s health priorities.
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“The medical field is starting to focus on women’s health more intensely because there is so much we have to learn about the normal hormonal changes that affect women throughout their lives,” says Sweeney.
One theory is that sad nipple syndrome may be linked to dysphoric milk ejection reflex (D-MER), which happens during breastfeeding.
D-MER causes sad or uncomfortable emotions just before your milk lets down.
Physically, the let-down reflex is a complex process that starts with the release of the hormone oxytocin. When your breasts are stimulated, that action causes nerve impulses to the brain stem and the hypothalamus resulting in a release of oxytocin and a reduction of dopamine. This fluctuation in hormones then allows for prolactin release and subsequent milk let down.
A let down can happen when your baby sucks on your nipple or even when you hear or think about your baby. But it’s the increase and decrease of specific hormones that may result in the experience of intense dysphoric emotions that are sometimes associated with breastfeeding.
The severity of D-MER varies just as much as its potential causes. Some view D-MER as an odd feeling that comes and goes and causes only momentary discomfort. Others may choose not to breastfeed because the discomfort and dysphoric feelings they experience are overwhelming.
“Being mindful of the effect an activity, even breastfeeding, is having on you is important so individuals can make the best decisions for themselves and their families,” says Sweeney.
Are the same changes in oxytocin and dopamine happening if you have sad nipple syndrome but have never breastfed? Research suggests they might. For example, one study found breast stimulation increased oxytocin levels in both lactating and nonlactating women.
“If the same activities can release oxytocin, they might also be signaling the hypothalamus to produce less dopamine resulting in those dysphoric feelings,” explains Sweeney.
Psychologically, researchers believe there may be additional causes for the dysphoric feelings associated with sad nipple syndrome that include postpartum mental health, feelings of incompetence or anxiety related to body image, and exposure to intimate partner violence.
Premenstrual dysphoric disorder (PMDD) is also known to cause severe anxiety, depression and mood changes in the days or weeks leading up to having a period.
“It may be that your body is just sensitive to these natural hormonal shifts,” she adds. “With PMDD, your body is reacting to these normal changes in hormones in a different way than the general population.”
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We are only starting to recognize how hormonal fluctuations vary. More research is needed to fully understand the dysphoric feelings that surface with sad nipple syndrome so we can develop more specific treatment options.
“Still, there are coping mechanisms you can put in place now to decrease distress around the symptoms you’re experiencing,” encourages Sweeney. “Coping skills can reduce how distressing symptoms are and, over time, they may also reduce the severity and impact of your symptoms.
“Even if your therapist is not familiar with D-MER or sad nipple syndrome, they could still use treatment such as cognitive behavioral therapy to help address your symptoms.”
Sad nipple syndrome may not yet be widely talked about with a body of research to back it up, but if you’re experiencing any sudden mood shifts or other symptoms, you’ll want to bring them up with a healthcare provider so they can begin to address them.
Keep track of your symptoms, how they affect your body, what time of day they occur and how long your symptoms last. If you have specific triggers like certain clothes, fabrics or bra types, or specific activities that result in dysphoric feelings, keep note of that, too. Also, track any solutions that help improve your symptoms.
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All of this is helpful information to have on hand when discussing your experiences with a healthcare provider. Plus, these records may improve your self-awareness around this issue, which, in turn, may impact the outcome more positively.
“Sometimes, just knowing what’s happening and how long it tends to affect you can feel like a huge relief,” encourages Sweeney.
Often, stress can have a huge impact on your physical and mental health. Finding ways to self-soothe in times of stress may help reduce the severity of your symptoms. But more than that, it could also improve your ability to react and respond in healthier ways.
“Our brains like to categorize experiences to events and specific stimuli,” explains Sweeney. “Use of coping skills such as meditation might decrease your negative reaction to nipple stimulation over time.”
At-home practices, such as mindfulness, meditation and deep breathing, may help you ride out the surge of dysphoric emotions you feel in response to nipple stimulation. These behaviors can also boost your overall mental health.
With D-MER, skin-to-skin contact with your infant is something you want to continue doing when you’re breastfeeding and in between meals.
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“There is a strong hormonal component to D-MER and sad nipple syndrome,” notes Sweeney. “Skin-to-skin contact produces more oxytocin, which may help with some of those dysphoric feelings.”
Skin-to-skin contact has both physical and psychological benefits, too. It improves parent-to-child bonding and enhances child development.
If you’re breastfeeding and you’re faced with dysphoric feelings, you may want to make an appointment with a lactation specialist. They can offer guidance on how to improve the breastfeeding experience. They can also offer additional referrals to a therapist who can help get to the bottom of why your dysphoric feelings may be happening.
Again, cognitive behavioral therapy (CBT) may be something you want to consider, particularly if your anxiety, depression and mood changes are disrupting various areas of your life or getting in the way of your relationships. In general, CBT is designed to help you identify your triggers and rely on coping strategies that work for you and your body as a means of improving your mental health.
“If sad nipple syndrome is interfering with your life, therapy might be a good option,” suggests Sweeney. “A therapist can help you process your negative feelings and recommend coping strategies. Over time, those strategies can really help you get through those moments when you’re in need of relief.”
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