Breast Health 101: What is Normal and What is a Concern?

Breast Health 101: What is Normal and What is a Concern?


  1. Hair on/around nipples. Just like other skin surfaces on the body, the areola (dark    circle               around the nipple) contains hair follicles, so hair on the breast is considered normal. Shaving or     plucking could lead to inflection, so if the hair is bothersome, it's best to cut with a small scissors. 
  2. Inverted nipples. This occurs when the nipple retracts into the areola. Approximately 10-20 percent of women have inverted nipples on at least one breast. Inverted nipples can also cause challenges for women who'd like to breastfeed, but they can be overcome.
  3. Discharge from nipples. Fluid can be expressed from the nipple ducts of at least 40 percent of pre-menopausal women, 55 percent of women who've had a baby and about 75 percent of women who have lactated in the last two years. The fluid generally comes from more than one duct and varies in color, either white, dark green or even brown. This type of breast discharge caused by manual expression is normal.
    Spontaneous nipple discharge should be evaluated by your provider. This can be caused by a variety of situations, including medication, chronic breast stimulation, thyroid disease or other chronic medical conditions. Bloody or straw-colored (serous) breast discharge, especially from a single duct, should always be evaluated by a provider.
  4. Bumpy nipples. The areola contains numerous lubricating glands, called "Montgomery glands." These show up as areola bumps and are completely normal.
  5. Areola color and areola types. Areolas come in all different sizes and colors, mostly due to hereditary factors. Some women notice dark areolas or an increase in size with pregnancy and breastfeeding, but these features usually return to pre-pregnancy appearance after breastfeeding is complete.
  6. Skin changes and stretch marks. Breast skin can be affected by common skin problems, including itchy, dry patches from psoriasis or eczema. It's also possible to get a rash from anything that comes into contact with breast skin (contact dermatitis), like clothing. Stretch marks are also normal and appear as red spoke-like lines, which appear on the skin during times of rapid physical growth, such as puberty or pregnancy. Over time, the stretch marks often fade.
    Some skin changes are not normal, including ulcerations, swelling (edema), scaling, crusting, redness, dimpling or skin retraction. Palpable breast masses should be evaluated by a health care provider. Most breast masses are benign and not cancerous, but it's important to see a provider for an exam and to discuss family history.
  7. Breast shapes and sizes. Heredity is the most important factor in determining how big breasts will be. No creams, special exercises or clothing will permanently change breast size. It may change with weight loss/gain or during/after a pregnancy, but for the most part, the size of your breasts stays the same after puberty. It is not unusual to have uneven breasts, as well. Because of different breast sizes, women may find that during lactation, one breast may produce more milk than the other.

"It is normal to feel subconscious about the way our breasts look or feel, but we are all unique and special," Dr. Cowman says. "As women's health care providers, we would be happy to discuss any of your concerns. Sometimes, just hearing things are normal can be very reassuring."

Men's Health: Prostatitis Explained

Prostatitis Explained

The prostate is part of the male reproductive system and while it usually goes unnoticed, it can become inflamed causing some discomfort. Urologist Brian Le, MD, UnityPoint Health, explains a condition known as prostatitis.

Types of Prostatitis

Dr. Le says prostatitis is an inflammatory condition of the prostate that may or may not be associated with infection. He says there are four different types.

  • Acute bacterial prostatitis
  • Chronic bacterial prostatitis
  • Chronic non-bacterial prostatitis (chronic pelvic pain syndrome)
  • Asymptomatic prostatitis (usually diagnosed from a biopsy)

“Acute bacterial prostatitis is the most worrisome, as patients can get very sick and possibly septic (severe infection that spreads to the blood stream),” Dr. Le says. “They can be unable to urinate, and it may be associated with high fevers.”

In the United States, prostatitis is most common in older men, above age 60.

Prostatitis Causes

Dr. Le says the cause of prostatitis is not completely understood. There are certain bacterial causes that lead to infection, but Dr. Le says that only makes up a minority of cases. Some sources also suggest it can be caused by excessive bike riding or pressure, certain foods, viruses, reflux of urine (urine that flows backwards) or immune disorders.

“We don’t think sexual intercourse causes prostatitis, though some patients report having symptoms shortly after a high-risk sexual encounter. It is unclear if that link is real or perceived due to anxiety. Sometimes, sexual activity can relieve symptoms of prostatitis,” Dr. Le says.

Prostatitis Symptoms

It’s hard to determine how many men have had prostatitis because many cases go undiagnosed. However, Dr. Le says it is common enough to be considered if there is a sudden, significant change in urinary symptoms or pain. The condition has a wide range of symptoms from severe to mild.

  • More frequent and/or urgent urination
  • Difficulty emptying the bladder
  • Pain in the groin
  • Pain in the perineum, area between the anus and scrotum
  • Pain in the penis
  • Fevers (severe cases)
  • Inability to urinate (severe cases)
  • Severe burning (severe cases)

If you notice any of these symptoms, contact your UnityPoint Health provider for a discussion.

Prostatitis Diagnosis and Prostatitis Treatment

There is no specific test to diagnose prostatitis, but a provider can come to the conclusion from a patient’s explanation of symptoms. In order to make the prostatitis diagnosis, Dr. Le says urine samples, cultures and secretions from the prostate may help eliminate other conditions.

While making the diagnosis, a provider may tell a patient he has a boggy prostate. The term is what your provider may use to describe how the prostate feels in comparison to a normal prostate.

“It means the prostate feels soft and spongy, which may be a sign of inflammation. Sometimes, the prostate can be very tender on examination,” Dr. Le says.

Once a diagnosis is reached, treatment depends on the determined cause. Dr. Le says treating chronic prostatitis or frequent cases can be challenging.

“If we suspect there is a good chance of a bacterial or infectious cause, your doctor may put you on an extended course of antibiotics. The longer dose allows for adequate tissue penetration, as shorter doses are unable to get in the prostate at sufficient quantities to get rid of any infection. You may also be told to use anti-inflammatories or pain medications. Also, for urinary symptoms, you may be placed on an alpha-blocker medication to help. For patients with major pain symptoms and no clear infectious cause, pelvic floor physical therapy can sometimes be helpful,” Dr. Le says.