Original Article

Application of Extra Virgin Olive Oil to

Prevent Nipple Cracking in Lactating Women
Marı́a José Aguilar Cordero, PhD • Norma Mur Villar, PhD •
Rafael Guisado Barrilao, PhD • Manuel Eduardo Cortés Cortés, PhD •
Antonio Manuel Sánchez López, BSc

ABSTRACT
Keywords Background: It is well established that extra virgin olive oil (EVOO), applied to the skin, has
extra virgin olive oil healing and anti-inflammatory properties.
(EVOO), Aim: To evaluate the effectiveness of EVOO in the prevention of nipple cracking in lactating
nipple cracking, women.
lactating women Methods: Experimental, prospective, randomized study of 300 lactating women, admitted to the
postpartum unit of the city’s general hospital (Cienfuegos, Cuba). The study was carried out in
2012. Eligible patients were randomized into two groups of 150 women. In Group 1, EVOO was
applied on the nipple after feeding, and in Group 2, drops of breast milk were applied to the
nipple after feeding. Clinical evaluations were made during the first week of treatment and after
the first month. All women who initiated breastfeeding were considered eligible to be included
in this study; breastfeeding was characterized as the moment of mother–child interaction with
suction on the nipple. Efficacy was evaluated quantitatively, as the absence of cracks in the nipple
during the first 2 weeks of lactation using as the proportion of women with or without nipple
cracks, and if present, whether they were moderate or slight.
Results: The quantitative efficacy was 97.3% and no adverse effects occurred in mothers and
newborns during the administration of EVOO.
Discussion and Conclusions: EVOO helps prevent nipple cracking in lactating women. It has
been shown to have protective effects when breastfeeding presents technical difficulties. This
conclusion is borne out by the frequency distribution results obtained, which reflect a significantly
higher proportion of nipple cracking in the population that was not treated with EVOO.
Linking Evidence to Action: Use EVOO to prevent nipple cracking during breastfeeding by
administering 3 drops on each nipple after each feeding. Decreased nipple cracking will reduce
pain and enhance breastfeedinging by administering 3 drops on each nipple after each feeding,
improving the health of mothers and infants.

BACKGROUND this problem include medication or the application of natural

Breast milk is the natural and best nutrition for children during
their first year of life, although, as an exclusive food, it is not
considered sufficient after the sixth month of life. The benefits
it provides are not only biological; breastfeeding is a unique
opportunity for a mother to achieve close contact with her baby
and strengthen the bond between mother and child. The breast
not only gives the child the best possible food, it also provides
affection, comfort and continuing stimulation, in every sense
(Aguilar Cordero, 2005). Thus, it is irreplaceable.
However, diverse problems may arise in the process of
breastfeeding, especially that of nipple cracking. This is often
caused by the incorrect posture of the suckling child. There-
fore, when breastfeeding is painful for the mother, the child’s
posture should be observed and corrected. Other approaches to
products, and in this respect the use of extra virgin olive oil
(EVOO) has been proposed.
Research has shown that olive oil strongly inhibits cellular
oxidation, and thus helps prevent many diseases and even pre-
mature aging (Villarrubia, González Álvarez, Costa, & Torres
Morales, 2006). Pliny the Elder, in the first century AD, made
use of olive leaves (either alone or mixed with oil or honey) to
heal ulcers, and the oil itself against fever, muscle fatigue and
tetanic convulsions. Homeopathic medicine prescribes olive
leaves and tree bark in infusion for hypertension, because it
contains a bitter glucoside that exerts a hypotensive action (Vil-
larrubia, et al., 2006).
Studies have identified a compound in EVOO, called oleo-
canthal (oleo, olive; canth, itching; and al, aldehyde), which,

Correction made after online publication November 17, 2015: Author names have been updated.
364 Worldviews on Evidence-Based Nursing, 2015; 12:6, 364–369.
C 2015 Sigma Theta Tau International
 Original Article
Table 1. Treatment With and Without Extra Virgin Olive Oil (EVOO)

Quality of
Treatment/ Skin Toxic Studying/ feeding Type of Type of Nipple
variables color habits working posture feeding birth cracking

No EVOO % White Tobacco Not working Good Breast Natural delivery Present
68.7, 5.3, 41.3, 11.4, 59.3, 50.7, 44.0,
Black 31.3 coffee 30.0, working 42.7, moderate 51.7, mixed 40.7 vaginal operative delivery or not present 56.0
neither 64.7 studying 16.0 poor 36.9 cesarean 49.3
EVOO % White Tobacco Not working Good Breast Natural delivery Present
82.7, 6.0, 27.3, 26.7, 70.0, 50.7, 2.7,
Black 17.3 coffee 14.7, working 47.3, moderate 54.7, mixed 30.0 vaginal operative delivery or not present 97.3
neither 79.3 studying 25.3 poor 18.7 cesarean 49.3

Table 2. Presence of Nipple Cracking and its Rela- are reflected in the inhibition of the generation of various re-
tionship With the Other Study Variables active oxygen species, and thus the suppression of phenomena
of lipid peroxidation, which are ultimately responsible for sys-
temic tissue damage (Villarrubia et al., 2007).
Variables Score Significance The undoubted immunological and anti-inflammatory ef-
fects of EVOO give rise to a potent antioxidant action that
Quality of feeding 12.166 .000 has been shown in various experimental models (Abdulrhman
posture evaluated:
et al., 2012; Cortés Castell et al., 2014; and Gungor et al., 2013)
moderate
and is apparent in various pathological processes in humans.
Quality of feeding 53.577 .000 It reduces tissue aggression and preserves anti-infective and
posture evaluated: anti-tumor mechanisms. Given the systemic nature of these
poor
actions, it seems reasonable to suggest there may be a cuta-
Exclusive 49.495 .000 neous outcome of the systemic effects of EVOO.
breastfeeding Current scientific opinion is that, among oil products, only
EVOO/no EVOO (1) 69.246 .000 EVOO is biologically functional in humans, presenting specific
trophic, anti-inflammatory and antioxidant actions (Villarrubia,
2000). The heating of olive oil, and its refining, both cause
the loss of many of its functional activities. Moreover, they
can generate toxic and clearly pro-inflammatory substances
(Villarrubia, 2000).
like ibuprofen and aspirin, can inhibit the activity of cyclooxy-
The skin is rich in fats, of different compositions and struc-
genase COX-1 and COX-2 enzymes, which is the basis for the
tures, and in this organ, in addition to the functions described
action of nonsteroidal anti-inflammatory drugs and analgesics
above, skin lipids play an important mechanical role. The bar-
(Whitehead & Rice, 2006). Fifty grams of EVOO contains up
rier responsible for skin permeability is located in the stra-
to 200 µg of oleocanthal, equivalent to 10% of the recom-
tum corneum and is composed primarily of ceramides, free
mended adult dose of ibuprofen for pain relief (Whitehead &
fatty acids, and cholesterol. The intercellular arrangement of
Rice, 2006).
In vivo experimental studies have demonstrated the anti- these lipids plays an important role in the regulation of water
inflammatory capacity of EVOO, as reflected in the in- exchange and storage processes in the skin and in the trans-
creased survival of animals lethally challenged with bacterial dermal permeation of oil-soluble agents (Bonilla Polo, Murillo
lipopolysaccharide. This outcome is related to the systemic Ramos, González Bonillo, & Sanz Pérez, 1997).
suppression of the production of tumor necrosis factor alpha, There is scientific evidence to recommend the oral adminis-
which is associated with many inflammatory processes of the tration of EVOO to prevent oxidative stress in skin, analogously
skin. In both cases, these anti-inflammatory effects of EVOO to its use for the prevention or treatment of systemic oxidative

Worldviews on Evidence-Based Nursing, 2015; 12:6, 364–369. 365


C 2015 Sigma Theta Tau International
EVOO and Nipple Cracking
damage (cardiovascular damage, for example). The data on the
anti-inflammatory and antioxidant activities of EVOO are con-
vincing, but few studies have examined the results of topical
application.
The genetic variety of the olive tree and the cultivation and
harvesting processes employed, together with the oil extraction
and conservation mechanisms, are what define its quality for
human use. Some studies have suggested that the topical ap-
plication of olive oil might be unpopular with users, due to its
smell and texture, and have recommended controlled studies to
corroborate its beneficial qualities (Lasarte Velillas, & Aguilar,
2009).
Thus, the scientific community continues to seek definitive
evidence of the beneficial effects of the phenolic compounds in
olive oil. Other lines of research focus on the role and effects of
the biological metabolites of the phenolic compounds in olive
oil, which are the major compounds present in plasma and
urine after the consumption of virgin olive oil. In addition,
studies in the field of nutrigenomics are being conducted to
determine whether the minor compounds of olive oil stimulate
the expression of disease-protective genes in animal models
and in humans (Mateos Briz, Pereira-Caro, Goya Suárez, &
Bravo Clemente, 2011).
It is very important for research to be continued on the
beneficial effects of consuming olive oil and its polyphenols.
In Mediterranean countries, it is culturally accepted that the
consumption of olive oil, and of EVOO in particular, is more
beneficial than that of other fats (Gungor et al., 2013, Veciana
et al., 2014).
It is well established that EVOO has healing and anti-
inflammatory properties. However, with respect to the prob-
lems of cracking nipples suffered by lactating mothers, the
current cultural understanding is that the application of drops
of breast milk is the most effective approach available.
GENERAL AIMS
To test the efficacy of the application of EVOO in alleviating
and preventing the problem of sore nipples in breastfeeding
mothers (compared to the use of breast milk).
Hypothesis
Previous studies have shown that EVOO has beneficial ef-
fects as an anti-inflammatory (Abdulrhman et al., 2012; Cortés
Castell et al., 2014; and Gungor et al., 2013). It is proposed in
this study that EVOO may also help prevent cracked nipples in
breastfeeding mothers.
Design
Experimental, prospective, randomized design to test the effi-
cacy of the topical application of EVOO (compared to breast
milk) on the nipples of lactating women.
366
METHODS
The study group consisted of 300 breastfeeding mothers, re-
siding in Cienfuegos, Cuba, and treated at the postpartum unit
of the city’s general hospital. The study was conducted between
January and December 2012. Eligible patients were randomly
divided into two groups of 150 women each. The intervention
and control group were:
Inset
Group 1: EVOO applied on the nipple after breastfeeding.
Group 2: Drops of milk applied on the nipple after breast-
feeding.
Clinical assessments were conducted in the first week
of treatment and after the first month of breastfeeding. All
women who initiated breastfeeding, characterized by the onset
of mother–child interaction and sucking on the nipple, were
considered eligible for inclusion. Mixed feeding was consid-
ered because sometimes breastfeeding with a baby bottle is
combined.
Inclusion Criteria
r Breastfeeding started during the first 12 hours after
birth (cracks appear after the first suctions).
r The provision of signed, informed consent by the
mother.
Exclusion criteria
r History of rejection of the use of natural oils.
r Medication applied to the nipple.
r Presence of cracks in the nipple.
r Evident mental incapacity to give consent to partici-
pate in the study.
Treatment
Means of administration, quantity, and frequency. One
drop of extra virgin olive oil (EVOO) was administered to the
intervention group, topically on the nipple after each feeding,
day and night, during the first two weeks. The first adminis-
tration was conducted by the nurses and the following by a
properly trained woman.
Evaluation of response to treatment. Responses evaluated
after 1 week, after 2 weeks, and after 1 month for the appearance
of cracks in the nipple (alteration in tissue integrity, through
visible macroscopic inspection).
Dependent variable. The presence of cracks in the nipple.
Independent variables (all the ordinal variables studied). For
the mother, these variables are age, skin color, toxic habits
(tobacco, caffeine, and drug consumption), and quality of the
feeding (posture). For the newborn, the variables are type of
delivery (dystocia or natural childbirth), gestational age (term,
postterm), and weight at birth (normal, high).
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C 2015 Sigma Theta Tau International

Outcome types. Integrity of the nipple was determined by
observation during breast examination performed in the pe-
riod of lactation. Adverse events were defined as any adverse
symptoms, due to the topical application of EVOO, of sufficient
intensity as to cause withdrawal from the study.
Data Collection and Analysis
Ordinal scales were dichotomized for the breast examination,
as the proportion of women with significant or total nipple
integrity versus those with altered nipple integrity (moderate
or slight). Effectiveness was defined as the degree to which a
treatment produces a beneficial effect, as assessed under the
ideal conditions of the present study.
Statistical Analysis
The quantitative methodology applied in this study was based
on the examination of two independent samples and on a study
population of two groups, with 150 subjects in each. The case
subjects were given a treatment consisting of the topical appli-
cation of EVOO during lactation, while the control group did
not use this product. Both groups were examined to determine
the presence and severity of nipple cracking.
The two samples were processed independently and then
pooled for comprehensive analysis. Descriptive statistics and
contingency tables were obtained and logistic regression anal-
ysis performed.
Ethical Aspects
The welfare of study participants is among a researcher’s fun-
damental responsibilities. The procedures followed were in
accordance with the ethical standards set out by the hospital
committee on institutional human experimentation and with
the Helsinki Declaration of 1975, revised in 2000 (available at
http://www.wma.net/es/30publications/10policies/b3/).
RESULTS
Of 315 women approached, 300 participated in the study. Re-
sponse rates were 95% at 1 week, 98% and 2 weeks, and 99%
at 1 month. The results of this analysis are presented in Tables
1 and 2.
Table 1 presents the descriptive results for the different
variables in the two samples, for each treatment administered.
There is a significant difference between the two groups as
regards the occurrence of nipple cracking; the mothers treated
with EVOO suffered a much lower occurrence (2.7%) than the
untreated mothers (44.0%).
Table 2 presents a logistic regression analysis of the re-
lationship between the dependent variable presence of nipple
cracking and the ordinal variables. The variables that were most
relevant for the study were selected. Evidently, there is a direct
relationship between the presence of nipple cracking and the
quality of feeding (posture), the type of feeding, and treatment
with EVOO. The other variables analyzed are excluded from
the regression model.
Worldviews on Evidence-Based Nursing, 2015; 12:6, 364–369.

C 2015 Sigma Theta Tau International
Original Article
DISCUSSION
Few studies have considered the application of EVOO in order
to prevent nipple cracking, but reviews of the topical use of this
substance have indicated that vegetable oils readily penetrate
human skin. However, different types of oils present different
rates of penetration (Mateos Briz et al., 2011).
Vegetable oil contains molecules that absorb oxygen from
the air. The oxygen saturates the double bond and generates
oxides that are polymerized to form an outer film. This takes
place over time as the oil dries out. In the mucosa, the absence
of a genuine stratum corneum and granular layer favors the
penetration and absorption of substances. EVOO, due to its
moderately acanthocytic effect, stimulates the spur cells in the
innermost layer of the epidermis, causing it to thicken, thus
providing the oil’s preventive properties against nipple cracking
(Abdulrhman, El Barbary, Ahmed Amin, & Saeid Ebrahim,
2012; Sánchez-Fidalgo et al., 2008).
There were significant differences between the study
groups regarding the appearance of nipple cracking; only 2.7%
of the women treated with EVOO suffered this condition, while
it affected 44.0% of those who received no such treatment.
Moreover, 70% of the women treated with EVOO breastfed
exclusively, and even when breastfeeding was prolonged, the
use of EVOO provided a high level of protection against nipple
cracking.
The results obtained also show that the breastfeeding pos-
ture was assessed as only moderate in both groups as the
women treated with EVOO were largely free of nipple cracking
problems, this suggests that the oil has a protective action even
when breastfeeding is performed inadequately. According to
earlier research findings, technical errors in the performance
of breastfeeding can provoke nipple cracking, which in turn
causes mothers to abandon natural feeding methods, and so
treatments that might prevent this condition are of great im-
portance (Aguilar Cordero, 2005; Aguilar Cordero, 2013).
In this respect, Gungor et al. (2013) compared the use of
lanolin and olive oil, using the mother’s other nipple as a con-
trol, thus, lanolin was applied to one nipple and olive oil to the
other. In this study, the majority of women expressed greater
satisfaction with the use of olive oil. The authors observed that
although this treatment has historically been shown to provide
evident benefits to health, it has received very little research
attention (Gungor et al., 2013).
In this study, we used EVOO, obtained from superior-grade
olives using a purely mechanical process, with no chemical
intervention. Its quality is confirmed by laboratory tests and
by sensory and organoleptic tasting. Oil of a lesser category
does not offer the same guarantees of quality as are certified by
the “extra virgin” denomination. The extraction process used
ensures that the components of the oil retain their organolep-
tic and nutritional properties and thus continue to provide
the beneficial effects observed in this study (Alba, Izquierdo,
Gutiérrez, & Vossen, 2008).
367
EVOO and Nipple Cracking
This research was conducted in Cuba, a Caribbean coun-
try with a tropical climate, which is seasonally humid with a
temperate, maritime influence, and high levels of solar radia-
tion throughout the year. The results obtained showed that the
application of small drops of EVOO directly on the nipple af-
ter breastfeeding provided considerable protection against the
appearance of cracks in the nipple. Furthermore, the climate
conditions do not appear to reduce the beneficial effects of the
oil.
The logistic regression analysis (Table 2) shows there is
a relationship between the dependent variable appearance of
nipple cracking and the independent variables posture, type
of feeding and EVOO treatment. We highlight the preventive
value of this natural product, which is greater than that of oil
lacking the “extra virgin” denomination (i.e., refined olive oil).
EVOO contains large quantities of antioxidants and vitamin A,
which are responsible for its healing and restorative qualities.
One of the relationships observed was that between the vari-
able appearance of nipple cracking and the quality of the breast-
feeding posture. A highly significant finding was the presence
of nipple cracking in women whose breastfeeding technique
was suboptimum. It has been reported elsewhere that when
the posture is not correct, the child’s mouth fails to cover the
entire nipple; in consequence, the vacuum created is incom-
plete and the milk is extracted poorly. Therefore, the early de-
tection of problems in applying the correct suction technique is
very important, in order to avoid nipple cracks, mastitis and hy-
pogalactia, which are the main causes of mothers’ abandoning
breastfeeding (Aguilar Cordero et al, 2012; Aguilar Cordero,
2010).
LIMITATIONS
The main limitation of this study was the difficulty of telephone
communication with women after childbirth to check if they
had sore nipples. Another limitation was the difficulty in mov-
ing the EVOO from Granada, Spain, to the city of Cienfuegos,
Cuba.
CONCLUSIONS
Our literature search found no references to previous stud-
ies of the effect of EVOO on the variables examined here.
However, research comparing the use of lanolin and breast
milk after feeding concluded that breast milk is preferable for
treating sore and cracked nipples, although lanolin produced
a longer lasting healing effect (Ledoux, Hingle, & Baranowski,
2011; Mohammadzadeh, Farhat, & Esmaeily, 2005). The re-
sults of large-scale prospective studies based on clinical events
such as incident cases of cardiovascular disease, cancer or dia-
betes mellitus corroborate the benefits of using EVOO. These
studies provide sufficient scientific evidence that EVOO can
prevent cardiovascular and degenerative diseases (Aros & Es-
truch, 2013; Arumugam et al., 2011; De Lorenzo, 2012).
The results of this study reflect the importance of using
EVOO to prevent sore nipples during breastfeeding and no ad-
verse effects occurred in mothers or newborns during the ad-
368
ministration of the product. EVOO continues to protect against
nipple cracking even when the feeding posture adopted is in-
adequate. WVN
LINKING EVIDENCE TO ACTION
r Use EVOO to prevent sore nipples during breast-
feeding by administering 3 drops on each nipple
after each feeding.
r EVOO did not produce adverse effects in mothers
and newborns.
r Seventy percent of the women treated with EVOO
breastfed exclusively during the first 6-month
period.
r There is a direct relationship between the decrease
of nipple cracking and the quality of feeding (pos-
ture) and the type of feeding.
Author information
Marı́a José Aguilar Cordero, Research Group CTS 367, Andalu-
sia, Spain, and Nursing Department, University of Granada,
Spain; Norma Mur Villar, Research Group CTS 367, Andalu-
sia, Spain, and University of Medical Sciences, Cienfuegos,
Cuba; Rafael Guisado Barrilao, Nursing Department, Univer-
sity of Granada, Spain; Manuel Eduardo Cortés Cortés, Math-
ematical Sciences, University of Technical Sciences, Cienfue-
gos, Cuba; Antonio Manuel Sánchez López, Research Group
CTS 367, Andalusia, Spain, and Nursing Department, Univer-
sity of Granada, Spain
Address correspondence to Dr. Marı́a José Aguilar Cordero,
Departamento de Enfermerı́a, Facultad de Ciencias de la Salud,
Universidad de Granada, Avda/de la Ilustración s/n, 18071
Granada, Spain; mariajaguilar@telefonica.net
Accepted 25 April 2015
Copyright 
C 2015, Sigma Theta Tau International
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