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As Jakub Plichta toed the starting line, he tried to prepare himself for the impending agony.
There would be shinsplints and shooting knee pain. There would be too many muscle cramps to count. And there would be that seemingly insurmountable exhaustion all marathon virgins experience when they hit the "wall" around Mile 20 or so.
He had heard it all: the nausea, the vomiting, the crying. This was going to hurt, and he knew it.
But nobody had told him about this.
At first, it was unnoticeable, no more than an irritation, a slight burning sensation. But when he looked down and saw the red streaks, the 31-year-old Mill Valley resident knew something was wrong. Like so many racers before him, Plichta had fallen victim to one of the most common -- yet little discussed -- ailments known to male long-distance runners. It is an injury that stings as much physically as it does mentally, a wound that leaves its victims humiliated and befuddled: bloody nipples.
"The pain I suffered was agonizing," recalls Plichta, a member of the Tamalpa Runners group in San Rafael. "But the pain was little compared to the embarrassment of running through the finish chute with bloodstains creeping down my pristine white shirt."
The bloodied nipple is running's dirty little secret. And now, as legions of runners from around the Bay Area and beyond train for the San Francisco Marathon on July 27, it is a wound waiting to claim countless new casualties.
"It feels like someone has stuck a needle into your nipple -- biiing!" says Fred D'Orazio, 60, an Oakland lawyer, veteran of five marathons (best time: 3:50), and chronic nipple bleeder. "Then it scabs up. It is extremely annoying."
The phenomenon of bloody nipples (medical name: "nipple chafing") is, curiously, an affliction suffered almost exclusively by male runners.
"Nipple chafing is an ailment that can and often does result in bleeding nipples," says Andre Chevalier, clinic director at TEAM Clinic Sports Medicine in Santa Clara. "It is the result of the constant up and down rubbing of a T-shirt against the nipple."
Chevalier says women's nipples don't tend to chafe because female runners typically wear a sports bra, which prevents the constant cloth-on-nipple rubbing that results in bleeding.
Chevalier couldn't say what percentage of men suffer from nipple chafing, but he calls the injury "common" for long-distance runners. Surfers are also susceptible, he says, because their chests rub against their surfboards so much. And although nipples can bleed in any weather, they are more susceptible in chilly temperatures (think foggy San Francisco days), when they are more prone to be erect.
But it's not all bad news. For instance, Chevalier says that some runners can build up a tolerance to the injury. "I don't want to say that you grow calluses on your nipples, exactly," he says. "But, for me, I build up a resistance from the beginning of my running season."
Others, though, are chronic sufferers.
"It is definitely not fun, and it takes a long time to heal," says Oakland resident Jim Granahan, a wholesale poultry salesman and runner of seven marathons (best time: 3:03). "But it does give you an awareness. I mean, I'm a guy, but now I'm aware that I have nipples too."
Adds Chevalier: "It is painful, especially when chafing is combined with a sunburn. The nipple becomes very sensitive ... very, very sensitive."
For victims of nipple chafing, the good news is that there are medically approved measures to prevent the hurt. For instance, the common Band-Aid can be placed over a nipple as protection. This can be problematic, however, for runners with hairy chests, as the adhesive tends to lose its stickiness when the hair becomes slick with sweat. To get around that, some men shave the areas around their nipples.
Then there are NipGuards, a patented Band-Aid alternative. The NipGuard is a circular bandage, so it clings only to the hairless nipple itself.
A tour of the NipGuards Web site shows dozens of testimonials for the product. Cheryl Tulcher of Flushing, Mich., writes that, thanks to NipGuards, "my tubby husband, Winston, no longer has the sorry excuse of "tender titties' to keep him from getting buff. He can just get his fat, lazy keester out of the Barcalounger and start running. I'm getting him several packages to put in his Christmas stocking."
But some runners are loath to stick bandages on their nipples. For these men, Chevalier recommends slathering the sensitive area with generous amounts of Vaseline. Jakub Plichta also subscribes to this method, adding that many refreshment stations at marathons now offer free Vaseline to participants.
Chevalier adds a final word of caution for men who decide to mix running and swimming. "Salt water on the chafed nipple creates a very intense stinging and burning," he says. "And anytime you go into a body of salt water with an open wound like a chafed nipple, it is subject to infection." In that case, he says, victims should immediately seek out a dermatologist.
Fred D'Orazio hopes it never comes to that.
"I really lather up [with Vaseline] now," he says. "I have these shirts that I use for long runs, and they all have two stains on the front from all the Vaseline buildup. I'm taking no chances."