Evidence-Based Recommendations for Nipple Therapy: Coconut Oil as a Preferred Alternative to Lanolin in Breastfeeding Support

Marie Farver, RN, IBCLC

10.27.2025

Abstract

Lanolin has long been recommended as a standard treatment for nipple soreness in breastfeeding mothers, yet recent evidence questions both its efficacy and safety. This review synthesizes current research examining lanolin's effectiveness in alleviating nipple pain and its association with increased infection rates, while exploring coconut oil as a superior alternative. A comprehensive analysis of systematic reviews, randomized controlled trials, and feasibility studies reveals that lanolin provides no significant benefit over no treatment or expressed breast milk (EBM) in reducing nipple pain. More concerning, preliminary evidence suggests lanolin use may be associated with substantially higher rates of bacterial and fungal infections compared to non-use. In contrast, coconut oil demonstrates effective moisturizing properties along with natural antimicrobial and antifungal activity, making it a safer and potentially more effective option for nipple therapy. Healthcare institutions should consider replacing lanolin with coconut oil in their breastfeeding support protocols to better serve the needs of lactating mothers.

Introduction

Nipple pain and trauma represent significant challenges for breastfeeding mothers, with prevalence estimates suggesting that a substantial proportion of women experience these complications during the early postpartum period (Jiménez Gómez et al., 2021). These symptoms can profoundly impact breastfeeding duration and success, potentially leading to premature weaning (Newby & Davies, 2016). The management of nipple soreness has historically centered on topical treatments, with lanolin emerging as the most widely recommended product by healthcare providers and retail markets alike.

Despite its ubiquity in postpartum care, lanolin's evidence base remains surprisingly limited and contradictory. The compound, derived from sheep sebaceous glands, has been marketed extensively to breastfeeding mothers with claims of promoting healing and reducing pain. However, recent systematic reviews and clinical trials have begun to challenge these assumptions, raising important questions about both efficacy and safety that warrant careful examination by lactation professionals and healthcare institutions.

This article presents a comprehensive review of current evidence regarding lanolin use for nipple therapy, examines emerging concerns about infection risk, and proposes coconut oil as an evidence-based alternative that offers both safety and therapeutic benefit for breastfeeding mothers.

The Evidence Against Lanolin

Lack of Efficacy for Pain Relief

A 2014 Cochrane systematic review evaluated interventions for treating painful nipples among breastfeeding women, including glycerin gel dressings, lanolin, and all-purpose nipple ointment (APNO) (Dennis et al., 2014). The review's conclusions were unequivocal: none of these treatments demonstrated effectiveness in alleviating nipple pain. Analyzing data from four trials encompassing 656 women, the researchers found no clear difference in nipple pain between women who used lanolin and those who applied nothing at all.

More striking was the finding that women who applied their own expressed breast milk experienced significantly less perceived nipple pain compared to those using lanolin (Dennis et al., 2014). This suggests that the simple, cost-free intervention of applying EBM may be superior to commercial lanolin products. Regardless of which treatment mothers used, nipple pain typically reduced to mild levels within 7-10 days postpartum, questioning whether any topical intervention beyond basic supportive care provides meaningful benefit.

A subsequent randomized controlled trial by Jackson and Dennis (2017) further confirmed these findings. In their study of 186 breastfeeding women with nipple pain and damage, participants were randomized to either lanolin application or usual postpartum care. The results revealed no significant differences in mean pain scores at 4 days post-randomization between groups. Both groups experienced clinically relevant decreases in nipple pain by 7 days, suggesting that natural healing processes, rather than lanolin application, primarily drive symptom resolution.

Association with Nipple Damage

Research suggests lanolin may fail to prevent nipple damage or, in some cases, may be associated with outcomes no better than other treatments. A 2015 double-blind randomized controlled trial by Shanazi et al. compared lanolin, peppermint, and dexpanthenol creams in 126 breastfeeding mothers with traumatic nipples. The study found that all three treatments had similar therapeutic effects on nipple trauma, with no significant differences between groups, suggesting lanolin offers no advantage over alternative treatments for managing nipple damage (Shanazi et al., 2015).

A 2017 randomized clinical trial by Vieira et al. compared anhydrous lanolin with breast milk combined with a breast shell for treating nipple trauma and pain. The study enrolled 60 postpartum women and found that the combination of breast milk plus a breast shell was significantly more effective than lanolin alone in reducing both trauma scores and pain intensity, suggesting that lanolin may actually be inferior to simpler, more accessible interventions (Vieira et al., 2017).

Earlier research by Melli et al. (2007) showed that nipple damage was more likely to occur among women using lanolin compared to peppermint oil gel, though differences did not reach statistical significance. Similarly, Dodd and Chalmers (2003) documented eight incidences of mastitis and candidiasis in their study, all occurring in the lanolin group with zero infections in the hydrogel group. While the authors noted these infections fell within expected ranges, the statistical analysis suggested a correlation between lanolin use and breast infection worthy of further investigation.

Infection Risk: The Most Concerning Finding

Perhaps the most telling evidence regarding lanolin comes from a 2014 feasibility study by Sasaki et al., which specifically examined the relationship between lanolin use and infection development in breastfeeding mothers experiencing nipple pain. Using retrospective chart review of 65 women with nipple pain from a private lactation consulting practice, the researchers compared infection rates between lanolin users and non-users.

The results were striking: among 38 women with nipple pain who did not use lanolin, 18% developed signs of nipple or breast infection. In contrast, among 27 women who did use lanolin, 62% developed signs of nipple or breast infection (Sasaki et al., 2014). This yielded an odds ratio of 7.5 (95% CI: 2.4-23.4), suggesting that lanolin users were more than seven times as likely to develop infection compared to non-users.

Among the 17 lanolin users who developed infections, fungal infection appeared to be the most frequent pathogen: 47% (8 women) resolved with antifungal treatment, 35% (6 women) required both antifungals and antibiotics, and only 17% (3 women) resolved with nipple hygiene alone (Sasaki et al., 2014). The predominance of fungal infections is particularly significant given the known relationship between moist environments and Candida growth.

Understanding the Mechanism: Moist Wound Healing Gone Wrong

The hypothesis that lanolin and moist wound healing may create an ideal environment for bacterial and fungal proliferation deserves serious consideration. While moist wound healing has proven beneficial in many clinical contexts, the unique environment of the nipple-areolar complex presents distinct challenges. The nipple and areola are self-lubricating structures containing sebaceous and apocrine sweat glands, with Montgomery glands providing natural protective secretions (Lawrence & Lawrence, 2011).

Applying occlusive substances like lanolin may disrupt this natural protective system. The combination of maternal skin flora, infant oral flora transferred during feeding, moisture from milk and saliva, and an occlusive barrier may create optimal conditions for microbial overgrowth. This concern is heightened by the fact that many women receive intrapartum antibiotics, with approximately 30-60% of birthing women potentially receiving IV antibiotics for Group B Streptococcus prophylaxis or cesarean section, placing them at increased risk for secondary fungal infections (Sasaki et al., 2014).

Lanolin Designated as the American Contact Dermatitis Society's 2023 Allergen of the Year

The 2023 designation of lanolin as the American Contact Dermatitis Society's Allergen of the Year highlights another important consideration: allergic contact dermatitis risk, particularly in individuals with chronic inflammatory skin conditions or compromised epidermal barriers (Johnson et al., 2023). While highly purified lanolin products have reduced free lanolin alcohols (FLA) to minimize allergenic potential, the risk remains present, adding another dimension to safety concerns.

Coconut Oil: An Evidence-Based Alternative

Moisturizing and Skin Barrier Properties

Virgin coconut oil (VCO) has been used for centuries in tropical climates as a natural treatment for wound healing. Research by Agero and Verallo-Rowell (2004) demonstrated that coconut oil functions as an effective moisturizer, capable of hydrating skin and increasing skin lipid levels in patients with mild to moderate xerosis. The compound's ability to improve skin barrier function makes it theoretically well-suited for treating nipple trauma and preventing further damage. Additional research by Varma et al. (2019) demonstrated VCO's anti-inflammatory and skin protective properties in vitro, providing mechanistic support for its therapeutic effects.

Evidence for Prevention and Treatment of Nipple Trauma

Recent clinical trials have provided compelling direct evidence supporting coconut oil's effectiveness for both preventing and treating nipple trauma. Alikamali et al. (2023) conducted a single-blind clinical trial with 106 primiparous mothers experiencing nipple fissures. Participants were randomized to apply either 0.5 mL of coconut oil three times daily or expressed breast milk after each feeding. The results demonstrated significant differences favoring coconut oil: on day 7, the coconut oil group showed superior outcomes for both nipple fissure healing (p=0.002) and pain intensity (p<0.001). By day 14, these differences persisted, with continued superiority in fissure healing (p<0.001) and pain reduction (p=0.036). The authors concluded that VCO may be used as a complementary substance to effectively treat nipple fissures.

Şahin et al. (2023) examined coconut oil and tea tree oil effects on nipple crack formation in 90 women during the early postpartum period. Their randomized controlled trial found that women applying coconut oil (30 participants) showed significantly better outcomes compared to controls at days 3, 7, and 10 postpartum in terms of nipple crack incidence. Visual analog scale (VAS) scores for nipple pain also demonstrated statistically significant improvements in the coconut oil group compared to controls (p<0.05). The researchers concluded that coconut oil reduced nipple crack formation and nipple pain, recommending increased use of coconut oil for breast problems in nursing care during the postpartum period.

Additional support comes from a 2021 Egyptian study by Hables and Mahrous, which compared olive oil, coconut oil, and breast milk in 135 postpartum women with nipple soreness. Using the Nipple Trauma Score (NTS) assessed at days 1, 7, and 14 post-intervention, the researchers found highly significant differences between groups, with both olive oil and coconut oil demonstrating superior effectiveness compared to breast milk alone (Hables & Mahrous, 2021). The study confirmed that coconut oil had a positive effect on managing nipple soreness, supporting its use as an effective therapeutic option.

Antimicrobial Properties: The Key Differentiator

What fundamentally distinguishes coconut oil from lanolin is its inherent antimicrobial activity. Coconut oil contains medium-chain fatty acids, particularly lauric acid and capric acid, which provide antimicrobial effects by disrupting bacterial, fungal, and viral cell membranes, leading to cell death (Elmore et al., 2014). Lauric acid, identified as a key active component, has demonstrated efficacy against a wide variety of skin bacteria, including gram-positive organisms such as Staphylococcus aureus and Streptococcus species, and gram-negative bacteria including Escherichia coli and Pseudomonas species (Dayrit, 2014; Elmore et al., 2014).

Antifungal Activity: Addressing the Candida Concern

Given that fungal infections appeared to be the predominant pathogen in the Sasaki et al. (2014) study of lanolin-associated infections, coconut oil's antifungal properties merit particular attention. Ogbolu et al. (2007) compared coconut oil to fluconazole for antifungal activity against various Candida species in an in vitro study. Their findings were remarkable: all Candida species tested demonstrated sensitivity to coconut oil, with the percentage of species sensitive to coconut oil exceeding the percentage sensitive to fluconazole at most concentrations. Most significantly, Candida albicans—the organism responsible for nipple and breast yeast infections and oral thrush in infants—showed the highest susceptibility to coconut oil.

This antifungal activity addresses a critical gap in nipple therapy. While lanolin may create conditions conducive to fungal overgrowth, coconut oil actively inhibits it. For mothers who have received intrapartum antibiotics and are therefore at elevated risk for Candida colonization, this distinction becomes particularly important.

Safety Profile and Practical Advantages

Topical coconut oil has been studied across diverse populations, including children, elderly individuals, and pregnant and lactating women, with adverse effects proving rare across all groups (Agero & Verallo-Rowell, 2004). Its food-grade nature means it is inherently safe for infant consumption, eliminating the need to wash nipples before breastfeeding—a significant practical advantage over some other topical treatments.

The solid form of coconut oil at room temperature has shown greater effectiveness than liquefied versions, likely due to better adherence and prolonged contact time with affected tissue (Elmore et al., 2014). Unlike lanolin's waxy, sticky texture, coconut oil is readily absorbed and less likely to stain clothing as lanolin does.

Importantly, coconut oil presents virtually no allergy risk compared to lanolin's known allergenic potential, making it a safer choice for mothers with sensitive skin or atopic conditions. Its availability and affordability—coconut oil can be purchased at any grocery store at reasonable prices—further enhance its accessibility compared to specialized lanolin products marketed specifically for breastfeeding.

Clinical Recommendations

The Primary Intervention: Optimizing Latch

It bears emphasizing that the most important intervention for nipple soreness remains correction of the underlying cause. Poor latch and positioning account for the majority of nipple pain and trauma cases (Bourdillon et al., 2020). Lactation consultants and healthcare providers must prioritize hands-on assessment and education to establish proper infant positioning and attachment before recommending any topical treatment. No topical agent, however effective, can compensate for ongoing mechanical trauma from suboptimal latch.

The Second Line: Expressed Breast Milk

Following latch correction, evidence supports the application of expressed breast milk and air drying as beneficial first-line approaches for nipple healing (Dennis et al., 2014). This intervention costs nothing, is always available to the mother, and has demonstrated superior outcomes to lanolin in reducing perceived nipple pain. The immunological properties of breast milk, including antibodies, growth factors, and anti-inflammatory components, may contribute to its therapeutic benefit.

When Additional Intervention Is Desired: Coconut Oil

When mothers desire or require an additional emollient beyond EBM, current evidence points toward coconut oil as the preferred option. Based on the research reviewed, the following recommendations are appropriate:

1. Selection: Choose coconut oil in its solid form, as this retains the maximum therapeutic properties, including lauric acid content.

2. Application: Apply a small amount to the entire nipple and areolar area before and/or after feeding. The oil need not be removed before the next feeding, as it is safe for infant consumption.

3. Frequency: Apply consistently during the period of nipple soreness until symptoms resolve.

Time to Switch from Lanolin to Coconut Oil

Given the current evidence base, healthcare providers and institutions should reconsider routine lanolin recommendation.

Institutional Implementation

Healthcare systems seeking to update their breastfeeding support protocols should consider:

1. Removal of lanolin from postpartum units: Discontinue routine dispensing of lanolin products to postpartum patients

2. Staff education: Train nurses, lactation consultants, and physicians on the evidence regarding lanolin and coconut oil

3. Provision of alternatives: Make organic virgin coconut oil available on postpartum units for mothers who desire an emollient

4. Patient education materials: Update written and verbal education to reflect current evidence, emphasizing latch correction, EBM application, and coconut oil as preferred options

Limitations and Future Research Needs

The evidence base supporting coconut oil over lanolin, while growing, would benefit from additional rigorous research. The Sasaki et al. (2014) study, despite its compelling findings regarding infection risk, was a small feasibility study limited by its retrospective design and inability to control for confounding variables such as hand hygiene. As the authors appropriately noted, their findings establish feasibility for a larger randomized controlled trial.

Such a trial should enroll women prenatally and assign them at birth to lanolin use after each feeding, no topical treatments, or coconut oil application, with follow-up for infection development. Groups should be stratified by presence of broken skin, peripartum antibiotic exposure, and type of infection when it occurs. Standardized instructions regarding hand hygiene and lactation support should be provided to all groups to minimize confounding. This type of study would provide definitive evidence regarding infection risk and could establish clear guidelines for clinical practice.

Finally, implementation science research examining how best to transition institutional practices away from lanolin and toward evidence-based alternatives would prove valuable. Understanding barriers to practice change and identifying effective strategies for disseminating new evidence to frontline providers remains an important area for investigation.

Conclusion

The widespread use of lanolin for nipple therapy in breastfeeding mothers represents a gap between common practice and evidence-based care. Current research demonstrates that lanolin provides no significant benefit over no treatment or expressed breast milk for reducing nipple pain, and preliminary evidence raises serious concerns about associated infection risk, particularly fungal infections. The finding of a 62% infection rate among lanolin users compared to 18% among non-users, yielding an odds ratio of 7.5, demands the attention of lactation professionals and healthcare institutions.

In contrast, coconut oil offers a compelling alternative supported by both traditional use and emerging clinical evidence. Its effectiveness as a moisturizer combined with natural antimicrobial and antifungal properties addresses both the symptoms and potential complications of nipple trauma. Recent randomized controlled trials have demonstrated superior outcomes for coconut oil compared to breast milk alone in treating nipple fissures and reducing pain, with safety profiles that make it appropriate for widespread use in breastfeeding populations.

Healthcare institutions and lactation professionals should prioritize evidence-based approaches to nipple therapy that begin with optimizing latch and positioning, proceed to expressed breast milk application, and offer coconut oil when additional intervention is desired. The routine recommendation of lanolin should be stopped in light of current evidence.

Supporting breastfeeding mothers through the challenges of early lactation requires that we base our recommendations on the best available evidence rather than tradition or commercial marketing. The emerging evidence strongly suggests that coconut oil represents a safer, potentially more effective alternative to lanolin for nipple therapy, warranting implementation in clinical practice.

References

Abou-Dakn, M., Fluhr, J. W., Gensch, M., & Wöckel, A. (2011). Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacology and Physiology, 24(1), 27-35. https://doi.org/10.1159/000318228

Agero, A. L., & Verallo-Rowell, V. M. (2004). A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis, 15(3), 109-116. https://doi.org/10.2310/6620.2004.04006

Alikamali, M., Emadi, S. F., Mahdizadeh, M., Emami, Z., Akbari, H., & Khodabandeh-Shahraki, S. (2023). Comparing the efficacy of breast milk and coconut oil on nipple fissure and breast pain intensity in primiparous mothers: A single-blind clinical trial. Breastfeeding Medicine, 18(1), 30-36. https://doi.org/10.1089/bfm.2022.0120

Bourdillon, K., McCausland, T., & Jones, S. (2020). Latch-related nipple pain in breastfeeding women: The impact on breastfeeding outcomes. British Journal of Midwifery, 28(7), 406-414. https://doi.org/10.12968/bjom.2020.28.7.406

Bourdillon, K., McCausland, T., & McCabe, M. (2023). Multi-residue analysis of certain lanolin nipple care products for trace contaminants. BMC Chemistry, 17, 8. https://doi.org/10.1186/s13065-023-00920-x

Dayrit, F. M. (2014). Lauric acid is a medium-chain fatty acid, coconut oil is a medium-chain triglyceride. Philippine Journal of Science, 143(2), 157-166.

Dennis, C. L., Jackson, K., & Watson, J. (2014). Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews, 12, CD007366. https://doi.org/10.1002/14651858.CD007366.pub2

Dennis, C. L., Schottle, N., Hodnett, E., & McQueen, K. (2012). An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: A randomized controlled trial. Breastfeeding Medicine, 7(6), 473-479. https://doi.org/10.1089/bfm.2011.0121

Dodd, V., & Chalmers, C. (2003). Comparing the use of hydrogel dressings to lanolin ointment in lactating mothers. Journal of Obstetrical, Gynecological, and Neonatal Nurses, 32, 486-494. https://doi.org/10.1177/0884217503255684

Elmore, L., Nance, G., Singleton, S., & Lorenz, L. (2014). Treatment of dermal infections with topical coconut oil. Natural Medicine Journal, 6(5). Retrieved from https://www.naturalmedicinejournal.com/journal/2014-05/treatment-dermal-infections-topical-coconut-oil

Hables, R. M., & Mahrous, E. S. (2021). Effect of olive oil, coconut oil, breast milk on nipple soreness among lactating mothers: Comparative study. Egyptian Journal of Health Care, 12(1), 987-994. https://doi.org/10.21608/ejhc.2021.165207

Jackson, K. T., & Dennis, C. L. (2017). Lanolin for the treatment of nipple pain in breastfeeding women: A randomized controlled trial. Maternal & Child Nutrition, 13(3), e12357. https://doi.org/10.1111/mcn.12357

Jiménez Gómez, M. I., Meneses Monroy, A., Corrillero Martín, J., Santana Gutierrez, S., Rodríguez Martín, R., & Girón Daviña, P. R. (2021). Prevalence of nipple soreness at 48 hours postpartum. Breastfeeding Medicine, 16(4), 325-331. https://doi.org/10.1089/bfm.2020.0112

Johnson, H., Norman, T., Adler, B. L., & Yu, J. (2023). Lanolin: The 2023 American Contact Dermatitis Society allergen of the year. Cutis, 112(2), 78-81. https://doi.org/10.12788/cutis.0825

Lawrence, R. A., & Lawrence, R. M. (2011). Breastfeeding: A guide for the medical profession (7th ed.). Elsevier Mosby.

Mariani Neto, C., de Albuquerque, R. S., de Souza, S. C., Giesta, R. O., Fernandes, A. P. S., & Mondin, B. (2018). Comparative study of the use of HPA lanolin and breast milk for treating pain associated with nipple trauma. Revista Brasileira de Ginecologia e Obstetricia, 40(11), 664-672. https://doi.org/10.1055/s-0038-1675180

Melli, M., Rashidi, M., Nokhoodchi, A., Tagavi, S., Farzadi, L., Sadaghat, K., ... Sheshvan, M. (2007). A randomized trial of peppermint gel, lanolin ointment and placebo gel to prevent nipple crack in primiparous breastfeeding women. Medical Science Monitor, 13(9), CR406-411.

Newby, R. M., & Davies, P. S. (2016). Why do women stop breast-feeding? Results from a contemporary prospective study in a cohort of Australian women. European Journal of Clinical Nutrition, 70(12), 1428-1432. https://doi.org/10.1038/ejcn.2016.157

Ogbolu, D. O., Oni, A. A., Daini, O. A., & Oloko, A. P. (2007). In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria. Journal of Medicinal Food, 10(2), 384-387. https://doi.org/10.1089/jmf.2006.1209

Şahin, E., Yildirim, F., & Büyükkayaci Duman, N. (2023). Effect of tea tree oil and coconut oil on nipple crack formation in the early postpartum period. Breastfeeding Medicine, 18(3), 226-232. https://doi.org/10.1089/bfm.2022.0260

Sasaki, B. C., Pinkerton, K., & Leipelt, A. (2014). Does lanolin use increase the risk for infection in breastfeeding women? Clinical Lactation, 5(1), 28-32. https://doi.org/10.1891/2158-0782.5.1.28

Shetty, A. P., Halemani, K., Issac, A., Venkataramana, M., Furtado, M., & Manoli, R. (2024). Effectiveness of the application of lanolin, aloe vera, and peppermint on nipple pain and nipple trauma in lactating mothers: A systematic review and meta-analysis. Maternal and Child Health Journal, 28(12), 2013-2025. https://doi.org/10.1007/s10995-024-04006-1

Vieira, F., Mota, D. D., Castral, T. C., Guimarães, J. V., Salge, A. K. M., & Bachion, M. M. (2017). Effects of anhydrous lanolin versus breast milk combined with a breast shell for the treatment of nipple trauma and pain during breastfeeding: A randomized clinical trial. Journal of Midwifery & Women's Health, 62(2), 196-202. https://doi.org/10.1111/jmwh.12600