Letters

Vasospasm of the nipple was described in 1970

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7094.1625a (Published 31 May 1997) Cite this as: BMJ 1997;314:1625
  1. Edmund Hey, Retired paediatriciana
  1. a 51 Alwinton Terrace, Newcastle upon Tyne NE3 1UD

    Editor—Like most of the problems encountered during lactation, the condition reported by Laureen and Carolyn Lawlor-Smith–vasospasm of the nipple1 –was well described by Gunther more than 25 years ago in a book that remains a much neglected repository of wisdom on such issues.2 Sudden localised pain, sometimes associated with a burning sensation, and an abrupt biphasic or triphasic change in colour are the cardinal features. Gunther spoke of the nipples suddenly blanching because of vasospasm and then becoming a mulberry colour as the blood supply was restored. The symptoms often develop quite suddenly after, or between, feeds. This is unlike the pain (and, occasionally, the blanching) experienced when poor positioning causes nipple trauma during lactation. Unfortunately, both conditions can coexist. Most women will have discovered for themselves that local warmth can help and that keeping warm can sometimes forestall trouble.

    The Lawlor-Smiths have done women a service by redescribing this entity. The challenge is to know what to do about it. We will have stronger grounds for identifying it as a form of Raynaud's phenomenon when nipple pain has been shown, under controlled trial conditions, to respond to some of the pharmacological manipulations that ease other symptoms of that condition.3 It seems odd that none of the women reported on had any other symptoms of the phenomenon. Labels are only of real use when they help us develop a logical therapeutic strategy.

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