Prevention and management of nipple wound: a systematic review

Abstract

Background

Nipple wounds are common complications during breastfeeding and may lead to pain, early cessation of breastfeeding, and maternal distress. Various pharmacological and non-pharmacological approaches have been proposed for the prevention and treatment of nipple wounds; however, evidence regarding their effectiveness remains inconsistent. This systematic review aimed to comprehensively evaluate current evidence on methods used for both the prevention and management of nipple wounds.

Methods

This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Literature searches were performed between March and April 2024 using the databases PubMed, Cochrane Library, Web of Science, and Scopus. To ensure that the review reflects the most up-to-date evidence, the search was repeated in January 2026 using the same databases and search strategy. No additional studies meeting the inclusion criteria were identified. Only studies published in English were included, and grey literature was not considered. MeSH terms and keywords including “wound,” “nipple wound,” “nipple trauma,” “nipple fissure,” “prevention of nipple wound,” and “treatment of nipple wound” were used in various combinations. Randomized controlled trials (RCTs) published within the last nine years were included. Study selection followed the PICOS framework. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists appropriate to each study design.

Results

Fifteen randomized controlled trials involving a total of 1,796 participants were included. The findings indicated that non-pharmacological interventions—such as proper breastfeeding techniques, nipple care education, breast milk application, and supportive devices—were effective in both preventing the development of nipple wounds and reducing the severity, pain, and healing duration of existing wounds. Compared with pharmacological treatments, non-pharmacological approaches demonstrated comparable or superior outcomes in several studies.

Conclusıon

The evidence suggests that non-pharmacological methods play a beneficial role in the prevention and treatment of nipple wounds. However, the effectiveness of these interventions should be interpreted with caution due to heterogeneity in intervention types, outcome measures, and variability in the methodological quality of the included studies. These interventions appear to be safe, accessible, and effective, particularly when integrated with breastfeeding education and support. Further high-quality randomized controlled trials (RCTs) with standardized outcome measures are needed to strengthen the evidence base and inform clinical practice.

Introduction

Breast milk, which is the best-known and most important for newborns throughout history, continues to be the most important nutritional source to ensure the survival of babies today [1, 2]. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend that the newborn start breastfeeding from the first hour of her life and receive breast milk for six months. It is important that breastfeeding continues during this period [3, 4]. The first two years after birth are important for children to have a healthy start to life and are called the “critical period” [5]. During this period, breast milk is recommended as the most suitable nutritional source for babies [1, 2].

In low-income and middle-income countries globally, only 49% of children under six months of age are exclusively breastfed. This rate remains well below the World Health Organization’s 2030 target of 70% of babies being breastfed [6]. In our country, according to the 2018 data from the Turkish Demographic and Health Survey (TDHS), the breastfeeding rate of newborns in the first hour after birth was determined as 71.3%. However, this rate drops to 41.7% in the first three days for various reasons. Again, while the 0–6 month breastfeeding rate of newborns is 40.7%, this rate is 14.6% in 6-8-month-old babies and 33.5% in 20–23 month-old babies [7]. Although studies are proving the benefits of breastfeeding in the first six months, mothers do not breastfeed their babies due to reasons such as nipple wounds, breast pain, and insufficient milk secretion, and the practices are inadequate [8–10].

If breast wounds are left untreated, they can result in complications such as intense pain, nipple bleeding, insufficient milk production, mastitis, and breast abscesses [11]. Breast trauma can decrease milk production and secretion, leading to stress in the mother and potentially halting breastfeeding due to its negative impact on oxytocin production [12]. The development of nipple wounds is multifactorial and is commonly associated with improper latch and positioning, ineffective suckling techniques, anatomical variations of the nipple, prolonged or frequent feeding without adequate support, and lack of breastfeeding education in the early postpartum period [13]. Therefore, it is crucial for mothers to receive support from employers, healthcare systems, communities, and families to maintain breastfeeding continuity [3].

The first days after birth are a very difficult period, especially for mothers who are breastfeeding for the first time. During this period, nipple pain and wounds occur at a rate of 80–90% [10–15]. These damages to the mother’s nipple should not be ignored to ensure the effectiveness and continuity of breastfeeding [15]. The focus should be on solutions that will be effective in a short time and will not harm the mother and baby.

Although numerous individual studies have investigated various non-pharmacological methods for the prevention and treatment of nipple wounds, their findings remain inconsistent, and a comprehensive synthesis of high-quality randomized controlled trials is limited [16–30]. Moreover, differences in study design, outcome measures, intervention protocols, and methodological quality have limited the ability to draw firm conclusions regarding the comparative effectiveness of these approaches. Previous systematic reviews and meta-analyses on nipple pain or trauma have addressed broader aspects of breastfeeding complications but have not specifically focused on non-pharmacological interventions or applied rigorous methodological criteria. To date, there is a lack of systematic reviews that specifically evaluate non-pharmacological interventions using rigorous methodological criteria.

Therefore, this systematic review aims to systematically examine the non-pharmacological methods used in the prevention and treatment of nipple wound among breastfeeding mothers. By synthesizing current evidence, this review seeks to clarify the effectiveness of these interventions, identify gaps in the existing literature, and provide evidence-based guidance for clinical practice and future research.

Research questions:

What is the evidence regarding the effectiveness of specific non-pharmacological methods used to prevent and treat nipple wounds and improve wound healing outcomes among breastfeeding women?

Materials and methods

This research was conducted as a systematic review to analyze the findings of studies evaluating methods for preventing and treating nipple wounds. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines [31].

Definition of nipple wound

For the purposes of this review, a nipple wound was defined as any visible tissue damage of the nipple occurring during breastfeeding, including fissures, wounds, abrasions, erosions, or ulcerations associated with pain, bleeding, or discomfort. Nipple pain without observable tissue damage was not considered a nipple wound and was therefore excluded, as the focus of this review was on clinically identifiable nipple wound rather than subjective pain alone.

Literature search

A literature search was carried out in the PubMed, Cochrane Library, Web of Science, and Scopus databases between March and April 2024 to identify studies related to the prevention and treatment of nipple wounds. The search was performed in English using the MeSH (Medical Subject Headings) terms and keywords “nipple wound,” “prevention of nipple wound,” and “treatment of nipple wound.” To ensure the currency of the evidence base, the search was updated in January 2026 using the same databases and search strategy. No additional studies meeting the inclusion criteria were identified.

To ensure the studies on nipple wounds were up-to-date, articles published in English between 2015 and 2024 with full-text availability were included. A total of 15 studies meeting the research criteria were selected as the sample for this review.

Inclusion and exclusion criteria

The studies included in this systematic review were selected based on the inclusion criteria established using the PICOS method (P=Population, I=Intervention, C=Comparison, O=Outcome, S=Study design). The detailed inclusion and exclusion criteria are provided in Table 1.

Table 1.

Inclusion and exclusion criteria

Inclusion criteria		Exclusion criteria
P	Breastfeeding women with clinically identified nipple wounds.	Women without nipple wounds or women experiencing nipple pain without visible tissue damage.
I	Non-pharmacological interventions aimed at the prevention or treatment of nipple wounds. These included behavioral interventions (e.g., breastfeeding education and positioning techniques), physical interventions (e.g., breast shells, hydrogel dressings, breast milk application), and complementary/alternative therapies not involving pharmacological agents.	Pharmacological treatments or studies not involving any intervention.
C	Routine nipple care, placebo, or alternative non-pharmacological interventions.	Studies with no comparator or unclear intervention protocols.
O	Studies reporting outcomes related to nipple wound healing, severity, pain reduction, or prevention.	Studies that did not report nipple wound-related outcomes.
S	Full-text randomized controlled trials published in English.	Observational studies, qualitative studies, reviews, case reports, conference abstracts, non-English publications, and studies without full-text Access.

This systematic review was conducted within the framework of midwifery practice and intentionally limited to non-pharmacological interventions. In many healthcare systems, pharmacological treatments for nipple wounds (e.g., topical antibiotics, corticosteroids, or medicated preparations) are prescribed and managed by physicians and generally fall outside the independent scope of midwifery care. Therefore, to maintain alignment with professional roles and clinical applicability within midwifery-led breastfeeding support, the review focused exclusively on conservative and supportive non-pharmacological approaches.

Additionally, restricting the scope to non-pharmacological interventions reduced clinical and methodological heterogeneity, as pharmacological treatments differ substantially in mechanisms of action, safety profiles, and regulatory considerations. This focused approach was intended to provide discipline-specific and practice-relevant evidence for midwives involved in breastfeeding management.

Study selection

Titles and abstracts were independently screened by at least two reviewers to identify potentially relevant studies. Full-text articles of selected studies were also assessed independently by the same reviewers. Any disagreements between reviewers regarding study eligibility were resolved through discussion and consensus; if consensus could not be reached, a third reviewer was consulted to make the final decision.

Data collection

The study was screened independently by the researchers. Summaries of the potential studies were reviewed, and any disagreements were resolved through consensus. The full texts of the potential studies were read independently by the authors to identify those that met the inclusion criteria. Additionally, the reference lists of all included studies and reviews were checked for relevant articles.

Separation and analysis of data

Initially, the titles and abstracts of the studies were reviewed and assessed, followed by a detailed examination of the articles with available full texts. After independently making their choices, the researchers compared their decisions and reached a consensus on any discrepancies. A standardized data extraction form was created by the authors to organize the information, and the data was analyzed accordingly. Using this form, information was gathered on the authors, publication year, study location, design, sample size and characteristics, frequency, duration, and period of application of non-pharmacological methods, as well as the measurement tools used in the studies included in the systematic review.

Methodological quality assessment

The quality of the studies was assessed independently by the researchers. The individual evaluations were compared, and a consensus was reached on any differing opinions. Furthermore, to assess the methodological quality of the studies included in this review, the Joanna Briggs Institute (JBI) critical appraisal tool, revised by Barker and Stone to assess the risk of bias in randomized controlled trials, was used. This tool consists of 13 items, with a total score ranging from 0 to 13. For each item, a “Yes” answer is assigned 1 point, while “No,” “Unspecified,” and “Not appropriate” answers receive 0 points. A higher score indicates greater methodological quality in the research [32].

Additionally, the possibility of publication bias, language bias, and performance bias was considered, recognizing that only English-language studies were included and that some small-scale studies with null results might not have been published.

Ethical aspect of the study

As the study employed a literature review model, it does not have a direct impact on humans or animals. Hence, ethics committee approval is not required.

Results

Selection of study

The initial database search yielded 287 records. After title screening, 272 studies that were clearly unrelated to the research topic were excluded. The abstracts and full texts of the remaining 15 studies were assessed in detail based on the inclusion and exclusion criteria. Ultimately, 15 randomized controlled trials met the eligibility criteria and were included in the review. A total of 1 non-English studies were excluded during the screening process due to language restrictions. The study selection process is illustrated in the PRISMA flow diagram (Fig. 1).

Fig. 1.

The PRISMA 2020 flow diagram

Characteristics of studies and participants

In total, 15 randomized controlled trials including 1,796 participants (sample sizes ranging from 60 to 300) were analyzed. Most studies were published after 2015 and were conducted in Turkey (5), Brazil (4), Iran (3), Japan (1), Bosnia and Herzegovina (1), and Cuba (1).

Outcome measures primarily included nipple wound severity, pain intensity (commonly measured using validated scales such as VAS or similar scoring systems), healing time, and maternal satisfaction.

Across studies, two main categories of interventions were identified: preventive interventions (aimed at reducing the incidence of nipple lesions) and therapeutic interventions (aimed at promoting wound healing and reducing pain severity once lesions had developed).

Preventive interventions, including cocoa butter, olive oil, and vernix caseosa, generally demonstrated a reduction in the incidence of nipple lesions compared with routine care. Therapeutic interventions such as lanolin, breast milk, herbal oils, and LED therapy were primarily associated with reductions in pain scores and accelerated healing time. However, the magnitude of effect varied across studies depending on intervention protocol and outcome measurement timing.

Features of nonpharmacological methods

The included studies reported variation in application frequency, duration, and administration methods.

Various topical agents (e.g., lanolin, coconut oil, olive oil, cocoa butter, honey, yarrow, Zizyphus jujube lotion) and supportive interventions (e.g., breastfeeding education, LED phototherapy) were applied at different postpartum intervals ranging from immediate postnatal application to follow-ups up to six weeks.

Despite differences in frequency and duration, most topical interventions were applied either after each breastfeeding session or at regular postpartum intervals (e.g., days 1, 3, 7, and 14), indicating a relatively consistent supportive-care framework across studies.

The heterogeneity in intervention protocols and follow-up periods limited direct quantitative comparison but allowed identification of general patterns of effectiveness.

Comparison group

Control conditions varied across studies. In eight studies, control groups received breastfeeding alone or routine breastfeeding practices [17, 19, 20, 22, 25, 27, 28, 30]. In five studies, standard care without additional intervention was provided [16, 18, 21, 23, 24].

Although control conditions differed, preventive interventions consistently demonstrated lower nipple lesion incidence compared to routine care. Similarly, therapeutic interventions showed greater reductions in pain scores and improved healing outcomes compared with standard care or breastfeeding alone.

The effect of nonpharmacological methods on breast wound

Non-pharmacological interventions significantly reduced nipple wound severity in 14 of the 15 included studies (Table 2).

Table 2.

Characteristics of studies examining the effects of non-pharmacological methods on nipple wounds

Author, Year of Publication, Country	Design of Study	Study population	Rating scale	Intervention	Control	Results obtained	Work quality according to JBI
Şahin et al., 2023, Türkiye	RCT	n = 90 (experimental group, coconut oil: n = 30; tea tree oil: n = 30; control group, n = 30)	Descriptive Information Form for Mothers, Early Postpartum Breast Problem Evaluation Form and Visual Analogue Scale (VAS)	Group 1, coconut oil; group 2, tea tree oil was applied.	No intervention was made	Coconut oil and tea tree oil have been found effective in reducing the formation of nipple cracks.	9
Serhatlıoğlu et al., 2023, Türkiye.	RCT	n = 90 (experimental group, wax: n = 30; breast milk: n = 30; control group, n = 30)	Personal information form, interim follow-up form, final follow-up form, Bristol Breastfeeding Assessment Tool (BBAT) and nipple/areola cracks severity form	Group 1, wax; group 2, breast milk was administered.	Routine hospital care was administered.	Beeswax is more effective than breast milk in preventing nipple crack formation. A wax barrier can be used to prevent nipple cracks.	10
Perić et al., 2023, Bosnia and Herzegovina.	RCT	n = 206 (experimental group, n = 103; control group, n = 103)	McGill Pain Questionnaire- short form, Nipple injury self-assessment questionnaire	Participants had a thin layer of 100% pure lanolin applied to the nipple after each feeding.	It was administered to participants by applying a few drops of their own milk to their nipples and allowing them to air dry.	Lanolin and breast milk are equally effective in treating damaged nipples.	12
Alikamali et al., 2023, Iran.	RCT	n = 98 (experimental group, n = 50; control group, n = 48)	Storr’s scale and visual analogue scale (VAS).	Coconut oil was applied.	They were trained to apply three to four drops of their own milk to their nipples after each breastfeeding session.	Virgin Coconut oil (VCO) has been found effective in treating nipple fissures.	10
Can Gürkan et al., 2022, Türkiye.	RCT	n = 72 (experimental group, n = 35; control group, n = 37)	Descriptive Questionnaire, Nipple Evaluation Form and IMDAT (Amount of Urine Output, Condition of Breasts, Amount of Stool, Weight Increase and Satisfaction Status)	Cocoa butter was applied.	Breast milk was administered.	Applying cocoa butter to the nipple has been found to be a more effective method than breast milk in preventing nipple pain, redness or problems in the nipple.	9
Tateoka, 2022, Japan.	RCT	n = 60 (experimental group, n = 30; control group, n = 30)	Preliminary patch testing.	Aloe arborescens fomentation was applied after breastfeeding.	No treatment was applied.	It showed that aloe supplementation was effective in reducing nipple-related complications.	9
Doğan Merih et al.,2021, Türkiye.	RCT	n = 64 (experimental group, n = 32; control group, n = 32)	Personal information form and nipple monitoring form	It was applied to vernix caseosa.	Breast milk was administered.	Nipple care with vernix caseosa is more effective than breast milk in preventing postpartum rashes and problems.	12
Sağlık and Kısacık, 2021, Türkiye	RCT	nn = 120 (experimental group, olive oil: n = 40; breast milk: n = 40; control group, n = 40)	Maternal information form, LATCH breastfeeding assessment tool, numerical rating scale (NRS) nipple/areola problems severity form	Group 1, olive oil; group 2, breast milk was administered.	No treatment was applied.	Olive oil is more effective than breast milk in preventing nipple problem formation.	9
Oliveira et al.,2020, Brazil.	RCT	n = 66 (experimental group, n = 33; control group, n = 33)	Breastfeeding tool form	Participants were given lanolin and health education about breastfeeding at two different times through a clinical demonstration using a fabric didactic breast and an explanatory album.	Standard health education was provided.	It is unclear whether the intervention combining lanolin with health education has a positive effect on preventing nipple trauma.	9
Firouzabadi et al., 2020, Iran	RCT	n = 150 (experimental group, yarrow: n = 50; honey: n = 50; control group: breast milk, n = 50)	Storr scale	Group 1, yarrow; group 2, honey was applied.	Breast milk was administered.	There was no significant difference in the severity of fissure score between the three groups. Honey, yarrow and breast milk have been found to be effective in treating nipple fissures.	9
Campos et al., 2018, Brazil.	RCT	n = 100 (experimental group, n = 50; control group, n = 50)	Phototherapy – Light Emitting Diode (LED), clinical parameters form for evaluation of stretch marks, pain scale, quality of life assessment tool	Light Emitting Diode (LED), treatment applied.	Training was given on breast care and adequate breastfeeding techniques.	The use of Light Emitting Diode (LED), therapy has been found effective in accelerating the healing process of nipple fissures.	9
Mariani Neto et al., 2018, Brazil.	RCT	n = 180 (experimental group, n = 90; control group, n = 90)	Nipple trauma score	Highly Purified Anhydrous (HPA) lanolin was applied.	Breast milk was administered.	Highly Purified Anhydrous (HPA) lanolin was found to be more effective than breast milk in preventing nipple trauma.	9
Shahrahmani et al., 2018, Iran.	RCT	n = 100 (experimental group, n = 50; control group, n = 50)	Amir scale	Jujube lotion was applied.	Breast milk was administered.	Zizyphus jujube fruit lotion was found to be more effective than breast milk in the treatment of breast fissures.	12
Vieira et al., 2017, Brazil.	RCT	n = 100 (experimental group, n = 50; control group, n = 50)	Nipple Trauma Score and McGill Questionnaire	Breastfeeding education was given. Anhydrous lanolin was applied.	Breastfeeding education was given. A combination of breast milk and breast shell was applied.	It has been found that the intervention with breast milk and breast shell is more effective than anhydrous lanolin in the treatment of nipple trauma and pain.	9
Cordero et al., 2015, Cuba.	RCT	n = 300 (experimental group, n = 150; control group, n = 150)	Ordinal scales for breast examination	Extra virgin olive oil (EVOO) applied to the skin was applied to the nipple after breastfeeding.	After breastfeeding, breast milk drops were applied to the nipple.	It has been found that EVOO reduces pain, strengthens breastfeeding and improves the health of mothers and babies by applying 3 drops to each nipple after breastfeeding in breastfeeding women.	9

RCT Randomized Controlled Trial, VCO Virgin Coconut Oil, EVOO Extra Virgin Olive Oil, HPA Highly Purified Anhydrous, LED Light Emitting Diode

When synthesized narratively, the overall direction of effect across studies favored non-pharmacological interventions for both prevention and treatment outcomes. Pain reduction was reported in the majority of therapeutic studies, with several demonstrating statistically significant decreases in mean pain scores compared to control groups. Healing time was also shortened in most intervention groups.

However, variability in outcome measurement tools, follow-up duration, and intervention protocols introduced clinical and methodological heterogeneity. Therefore, while the trend of benefit was consistent, the strength of evidence should be interpreted with caution.

One study [24] did not demonstrate a clear benefit, underscoring the need for further high-quality and standardized randomized controlled trials.

Overall, the findings suggest that non-pharmacological approaches used within midwifery-led breastfeeding care provide clinically meaningful improvements in nipple pain and wound healing, although standardized outcome reporting is needed to strengthen future evidence synthesis.

Discussion

This systematic review examined the effectiveness of non-pharmacological interventions used in the prevention and treatment of nipple wounds among breastfeeding women. A total of 15 randomized controlled trials were included. Although the studies varied in sample size, intervention protocols, and outcome measurement tools, the overall direction of evidence suggests that non-pharmacological interventions are associated with reductions in nipple pain and improvements in wound healing outcomes. However, the methodological diversity across studies requires careful interpretation of the magnitude and consistency of these effects.

Fourteen of the included studies reported positive effects of non-pharmacological interventions, whereas one study did not demonstrate a statistically significant benefit [24]. This discrepancy highlights the importance of considering study quality, intervention duration, and outcome measurement differences when interpreting pooled findings.

When examined in relation to individual studies, the findings of this review are largely consistent with previously published randomized controlled trials. Sahin et al. (2023) reported that coconut oil and tea tree oil reduced nipple wound formation and nipple pain [19]. Serhatlıoğlu et al. (2023) found that beeswax was more effective than breast milk in preventing nipple pain and crack formation [16]. Perić et al. (2023) reported that lanolin and breast milk were similarly effective in the treatment of painful and damaged nipples [17]. Alikamali et al. (2023) concluded that virgin coconut oil (VCO) may be used as a complementary topical agent in the management of nipple fissures [19]. Can Gürkan et al. (2022) demonstrated that cocoa butter was more effective than breast milk in preventing nipple pain, redness, and early postpartum nipple problems, suggesting its prophylactic potential [20]. Tateoka (2022) reported that aloe-based applications were effective in reducing nipple-related complications [21].

Dogan Merih et al. (2021) showed that vernix caseosa significantly reduced nipple pain and rashes by the seventh postpartum day and was more effective than breast milk in preventing nipple problems [22]. Sağlık and Kısacık (2021) concluded that olive oil and breast milk reduced nipple pain, prevented nipple damage, and improved breastfeeding comfort and maternal satisfaction [23]. Oliveira et al. (2020) found that lanolin combined with breastfeeding education did not demonstrate a clear preventive benefit regarding nipple trauma [24]. Firouzabadi et al. (2020) recommended honey, yarrow, and breast milk as supportive options in breastfeeding counseling and emphasized the therapeutic potential of honey and yarrow [25].

Mariani Neto et al. (2018) supported the use of highly purified anhydrous (HPA) lanolin in the treatment of nipple pain and trauma [27]. Shahrahmani et al. (2018) reported that Zizyphus jujube fruit lotion reduced nipple pain and accelerated healing compared with breast milk, without reported adverse effects [28]. Vieira et al. (2017) found that the combination of breast milk and breast shell was more effective than anhydrous lanolin in relieving nipple pain and promoting healing [29]. Cordero et al. (2015) emphasized the preventive role of extra virgin olive oil (EVOO) in reducing nipple pain during breastfeeding and reported no adverse effects in mothers or newborns [30].

When interpreted collectively rather than individually, the evidence indicates a consistent direction of benefit favoring non-pharmacological approaches for both prevention (reduced lesion incidence) and treatment (pain reduction and improved healing). However, differences in intervention frequency, duration, and outcome assessment tools limit direct cross-study comparison.

Importantly, pharmacological treatments were not included in this review, as they are generally prescribed and managed by physicians and fall outside the independent scope of midwifery practice. Therefore, the present findings should not be interpreted as evidence that non-pharmacological interventions are superior or equivalent to pharmacological therapies.

At this stage, the available evidence does not allow definitive conclusions regarding whether these methods should replace, complement, or be prioritized over pharmacological treatments in clinical practice. Comparative randomized controlled trials directly evaluating pharmacological and non-pharmacological strategies remain limited.

From a clinical perspective, non-pharmacological methods offer advantages such as accessibility, ease of application, low cost, and minimal reported adverse effects [20, 22, 30]. These characteristics support their consideration as supportive or first-line conservative strategies in breastfeeding care, particularly in mild-to-moderate cases. However, pharmacological management may still be necessary in cases involving infection, severe trauma, or complications requiring medical evaluation.

Separating prevention-focused outcomes from treatment-focused outcomes enhances clinical applicability by clarifying when and for whom each intervention may be most appropriate.

In conclusion, existing evidence supports the use of non-pharmacological methods in both the prevention and treatment of nipple wounds during breastfeeding. Nevertheless, these findings should be interpreted as supportive evidence within midwifery-led care rather than definitive guidance for replacing pharmacological treatment. Further well-designed randomized controlled trials with standardized outcome measures and direct comparative designs are needed to strengthen clinical recommendations.

Limitations

A limitation of this systematic review is that only studies published in English were included, which may have resulted in language bias. Additionally, clinical and methodological heterogeneity across studies limited the ability to perform quantitative synthesis and restricted the strength of comparative conclusions.

Conclusion

Based on the evidence synthesized in this systematic review, non-pharmacological interventions were found to be beneficial in both the prevention and treatment of nipple wounds, promoting wound healing, and supporting breastfeeding continuity among women with nipple wound .The findings indicate that preventive interventions, such as proper nipple care practices and protective applications, may reduce the incidence and severity of nipple wounds, while therapeutic non-pharmacological methods contribute to symptom relief and tissue recovery once wounds have developed. However, variations in outcome measures and study designs limit the comparability of results, underscoring the need for future research with higher methodological rigor, larger and more diverse samples, standardized outcome measures, and the use of randomization and blinding to strengthen the evidence base.From a clinical perspective, the results support the integration of evidence-based non-pharmacological methods into routine nursing and midwifery care for both the prevention and management of nipple wounds. Such approaches can promote sustained breastfeeding, and improve overall maternal–infant health outcomes.

Authors’ contributions

Literature search: NA, HÖ and EKSData collection: NAStudy design: NA, HÖ and EKSAnalysis of data: NAManuscript preparation: NA, HÖ and EKSReview of manuscript: NA, HÖ and EKS.

Funding

This research did not receive any specific grant from any kind of funding agencies.

Data availability

The data supporting the findings of this study are available upon request from the corresponding author. Due to privacy or ethical limitations, the data are not accessible to the public.

Declarations

Ethics approval and consent to participate

This study did not involve any procedures that required an ethical declaration.

Competing interests

The authors declare no competing interests.