‘The nipple touch of doom’: what is sad nipple syndrome and what causes it?

People everywhere are searching for the reason behind their sudden bursts of anguish or homesickness

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Some say it feels like a sudden burst of anguish; others liken it more to homesickness. The sudden onset of a sinking, upsetting feeling due to nipple stimulation is anecdotally known as Sad Nipple Syndrome (SNS), and for Sandra, it can be triggered by something as commonplace as putting on a shirt.

“I was probably a child when I first noticed: ‘Why does touching my nipple make me sad?’” says the 28-year-old. The sensation seemed to happen at random, and without the words to describe it, she kept it a secret. It wasn’t until college that she worked up the courage to Google it. “I realized I wasn’t crazy,” she says.

There are many others like Sandra (who, for privacy, has asked to use a pseudonym). Breastfeeding mothers, queer lovers and cis men alike have all sought an explanation for this phenomenon.

Sad Nipple Syndrome is often discovered in private. People describe it as a sudden dysphoria (a profound state of unhappiness or uneasiness) that follows nipple stimulation. It is often resolved within a couple of minutes, but can cause confusion and disruption.

I spoke to four people who experience SNS, and each described similar negative feelings. Sandra described it as “dread, a nostalgic sadness or the feeling of a bad memory”. Salma Zaky, a New York-based comedian who has talked about her SNS on stage, says she can “tell if a woman has gone through it – they’ll light up or clap”. Zaky likens it to a mix of homesickness or nostalgia.

For Sandra, the most common trigger is a light, unexpected touch when changing clothes or towel drying. Its intensity can vary depending on the circumstances. For instance, if she triggers the feeling on her own with light touch, “the negative feelings tend to persist for more than just a few seconds,” says Sandra. If there is sustained friction with her clothing, she sometimes feels “deep grief”.

Their sentiments are echoed in thousands of online posts asking whether anyone else experiences the “nipple touch of doom”. In the absence of a formal clinical diagnosis, most people’s understanding of Sad Nipple Syndrome has come from word of mouth or chatter online.

“Reddit was helpful in just being like: ‘Oh, I’m not an insane person,” says Zaky. “Other people feel this too.”

SNS is not an official medical diagnosis, and scientific research remains in short supply. That said, awareness is growing, even among researchers and medical practitioners.

As with many conditions that primarily affect women’s intimate or hormonal experiences, there is not much medical curiosity, funding or research. “While there is no explanation yet, we can assume that the hormone oxytocin is somehow involved, since nipple stimulation leads to its release,” says Dr Vladimír Kraus, PhD, Department of Gynaecology and Obstetrics at Pavol Jozef Šafárik University.

Oxytocin is often referred to as the “love hormone”. Largely responsible for bonding and increased emotional connectivity, it is triggered by physical touch like hugging, massage or sex, and also after uterine contractions during childbirth or breastfeeding. When it comes to its role in SNS, Kraus theorizes that “some subtle changes may cause the [oxytocin signaling pathway] to go haywire and [could] be responsible for the surprisingly prompt and very negative feeling experienced”.

There are no SNS-specific studies, but there are two more well-studied conditions that are similar enough to help us understand it. The first is dysphoric milk ejection reflex, or D-MER, which occurs during breastfeeding. It is an emotional response to the milk letdown, the moment where milk starts flowing out of the milk duct. People commonly describe the sudden rush of emotion as homesickness, sadness, loss of hope, worthlessness, shame and guilt, according to Alia Macrina Heise, an international board-certified lactation consultant and an expert on D-MER in Naples, New York. “It is disruptive to the duration of lactation and to the mother’s experience of breastfeeding and bonding,” she says.

SNS and D-MER present identically, and are also similar to post-coital dysphoria, says Heise. While SNS and D-MER are focused on nipple stimulation, the negative feelings people experience with post-coital dysphoria occur after the hormonal spike of orgasm. Anyone who has one of these conditions “will describe the embodied emotional sensations basically exactly the same way, even though the cause and the trigger is different”, says Heise.

The prevailing theory is that these three conditions involve a “hormonal cocktail inside the body”, says Heise.

The two most relevant hormones are prolactin and dopamine. This cocktail Heise refers to affects every human in a multitude of ways. “Prolactin and dopamine have a known relationship inside the human body – male, female, breastfeeding, not breastfeeding, in sexual arousal, in orgasm,” says Heise. Prolactin also contributes to weight control, immunoregulation, stress adaptation and maternal behavior.

Meanwhile, dopamine drives the brain’s reward system, playing a key role in movement, pleasure, desire, motivation and thinking. “Dopamine is often called prolactin’s gatekeeper,” explains Heise. In order for prolactin to flow into the body, dopamine has to allow prolactin through in order to complete one of its many jobs.

It’s possible that what happens in SNS, D-MER and post-coital dysphoria has to do with the way prolactin and dopamine go about their daily duties. One possible explanation is “inappropriate dopamine activity”, says Heise, who first heard a colleague mention SNS in the 2000s. “With dopamine being a mood stabilizer, that inappropriate activity is causing a mood destabilization that lasts for a very short amount of time.”

There is a growing body of research focused on D-MER, but to truly understand these conditions, we need more specialized studies. Without a clearer picture, sufferers are left feeling alone and “crazy”. Even if they work up the courage to ask their doctor about it, most medical professionals don’t have enough experience with these conditions to recommend treatment.

Techniques for reducing the severity of symptoms are mostly experimental. “One of the tricks that we’ve found helps the most by also targeting the dopamine system is cold therapy,” says Heise, who’s worked with thousands of breastfeeding mothers with D-MER. “Mothers drinking ice water or putting cold wraps around the back of their neck and cooling down their face and mouth receptors before letdown significantly eases the symptoms because it increases prolactin levels.” But whether this trick works for people with SNS is unknown.

Unexplained physical phenomena can be confusing and distressing, especially when they involve intimate body parts. The impact of SNS goes beyond the brief sensations, to shame and confusion over what they might mean.

Without formal answers from the medical community, many have developed theories about the causes, including forgotten sexual trauma, questions about one’s sexuality and marital doubts. These unfounded explanations can do real harm.

Kraus says SNS has rarely come up in his practice, but those who experience it often feel concerned “about their mental state or fear that they don’t like their partner or sex”.

As with all sexual preferences or personal boundaries, clear communication is key, experts say. It may also feel challenging or personal for partners of people who experience SNS.

“This isn’t about you, and it isn’t rejection,” says Dr Jennifer Lincoln, a board-certified OB-GYN and author in Portland, Oregon. “Talk about it outside the bedroom, agree on a signal to pause or change what’s happening, and let the person with the reaction lead.”

It can be tricky to bring up something you might not even know the name for, feel ashamed of or confused by. But talking about it can be helpful.

“Even just naming [Sad Nipple Syndrome] helps a lot, because many people think they’re going crazy – or with D-MER, that they are a bad mother,” says Lincoln. Similarly, shame can arise when SNS leads to negative experiences during sex and intimacy.

“I just avoid any nipple stuff during sex now, and it’s completely fine,” says Zaky.

“It pretty much has not impacted my sex life at all,” says Sandra. “I think the hardest part was simply feeling like a weird freak, and having a reaction that can’t be explained.”

Ivana Rihter is a writer in Chicago whose work has appeared in Vogue, Vanity Fair, Slate, Nylon and more