Ovarian cancer and your sex life

How will ovarian cancer affect my sex life

Sexuality and sexual activity is an important part of ourselves, but it sometimes gets ignored during ovarian cancer treatment and care. The need for touch, closeness, intimacy and reassurance may be more important than the need or desire for sex. Sex is much more than sexual acts. You do not stop being sexual just because you have ovarian cancer! Sex in all its forms can be a very valuable therapy to help cope with having treatment for cancer.

However, your sexuality can be affected by finding out you have cancer, the thought of the treatments you will have to go through and your worries about the future.

Most people experience some difficulty in their sex life at one time or another, particularly at times of change. How you want to express your sexuality is not fixed and changes over time for everyone. Having ovarian cancer is a life-changing event, which can affect your sex life in different ways.

Changes can happen from the time of diagnosis onwards. However, your first thoughts may be more concerned with coping with the diagnosis, treatment and getting through it all. It is later on, when you are ready to start or get back to having a sexual relationship, that you may notice some difficulties.

These may include less desire to be sexual, physical difficulty with vaginal penetration, pain or discomfort during sex and loss of enjoyment. You may experience changes in the way you feel about your body or in how you behave with your partner.

The physical and psychological effects of your cancer and its treatments can affect how you respond sexually. There are ways to manage these effects.

Physical effects

Experiencing ovarian cancer and its treatment can leave you with low energy levels, bowel and bladder problems, loss of feeling around your vagina, scarring, fertility problems and early menopause. Not surprisingly these can have a direct effect on your sexual relationships by affecting your interest in sex or comfort and enjoyment during sex.

Your vagina may also become drier, due to the lack of the hormone oestrogen which can make some sexual activity difficult and painful. Vaginally applied oestrogen may be offered as a long-term treatment for vaginal dryness and, also, urinary symptoms.

Surgery may shorten your vagina. If you have had radiotherapy, you may find that you have reduced space and lubrication in your vagina. Some people develop internal scarring and adhesions (bands of scar tissue that can make the tissues and organs inside your body stick together) which may cause pain each time they have sex. Not being sufficiently aroused can also lead to painful sex.

Taking time to work out what suits you now can help. This means allowing time to become aroused and sharing this with a partner if you have one. Talking to your team about any pain you are experiencing and how this can be managed, can all help.

It may be that sex is painful when first having intercourse following surgery and it will settle as your body recovers. Take your time.

The quality of orgasm you experience may change if you have had a hysterectomy (had your womb and cervix removed). If your pleasure during orgasm had previously centred on cervical stimulation or your womb contracting, you may get sensation from stimulating your clitoris or vagina. If you enjoy the sensation during penetration of being filled up, this may change if your cervix has been removed.

Vaginal dilators can help with scarring or shortening of the vagina, and your team can provide these and advise you how to use them. Some people prefer to use a slim sex toy as it feels less clinical and is an alternative for those who find the NHS dilators uncomfortable to use.

A vibrator will also boost blood flow to the tissues of the vagina which can promote healing, increase your own natural lubrication and arousal, and help any decrease in sexual sensation.

For some people, dilation therapy may be triggering or upsetting, especially if you are not used to having anything in your vagina. If you struggle with dilation therapy, talk to your clinical nurse specialist or other keyworker. They are there to support you.

Watch: 'Sex and intimate health after treatment', a webinar with Jo Divine co-founder, Samantha Evans

Psychological and emotional effects

If the way you see your body changes, you can feel depressed. After your experience of cancer and treatment you may have understandable emotions such as anxiety, fear, guilt and a sense of isolation. These emotions can affect how you feel about sex, your body image and attractiveness.

You may have worries that you find embarrassing to talk about to your partner, and this can also hold you back sexually. If you cannot carry on as before, loss of the ‘old you’ and uncertainty about the future can all be hard to accept and affect your psychological and sexual wellbeing.

You may find that your emotions are harder to manage around the time of your check-up or other significant occasions.

Watch: 'Sex and initimate health after treatment: coping with the emotional impact', a webinar with psychosexual therapist, Julia Pugh

Social effects

Your experience can give you low self-esteem and make you feel less confident to go out which can have an effect on your relationships and your sex life. Today’s society places so much emphasis on appearance that it is easy to feel less attractive and less sexy as a result of your cancer and its treatments.

Partners

Partners also sometimes have to adjust. Your partner may need some time to accept what has happened to you and the effect this may have on your relationship. Or you may feel under pressure to maintain sexual activity from frustrated partners who may be alarmed and distressed that your serious illness could mean the end of their sex life.

Couples may find new ways of achieving mutual sexual pleasure by experimenting. For many, it is the overall quality of their physical intimacy and pleasure that matters most.

If your partner is male and you want to have penetrative sex, you can try sexual positions where you control the depth of his penetration. Toys such as the OhNut are also helpful in controlling how deep penetration is, by acting as a soft buffer.

Communication is so important. Being able to talk openly about your feelings can help make things easier. Counselling at Relate can be helpful if you are having problems in your relationship.

Masturbation

Masturbation is a way to experience sexual pleasure on your own and can help with understanding your sexual responses after treatment.

You may want to try using sex toys. This can be a simple way to step back into enjoying sex and can be fun to use alone or with a partner. Toys can help vaginal tightness, decreased sensation and be another way of experiencing sexual pleasure.

Make sure they are made from skin safe non-porous material such as silicone, glass or metal (not rubber, latex or jelly) and are easily washable, to avoid skin irritation and infection. Use a lubricant (see below) but remember silicone lubricants are not suitable with silicone sex toys, which will need a water-based lubricant.

You may want to try masturbating with a partner as a way of experiencing orgasm and intimacy together.

Moving forward

Your specialist or GP should be able to provide medication to relieve symptoms such as feeling sick and pain.They can also prescribe certain lubricants.

Massage, makeovers and relaxation techniques can help put you back in touch with your body and improve your general wellbeing and self-esteem.

It often helps to know how others feel after their cancer treatments, so going to a support group can be useful.

Discussing intimate sexual matters can be embarrassing. However, your sex life is important, so you should talk about any worries you have as soon as you feel ready.

Getting help such as counselling gives a more successful result than not doing anything about sexual problems. Counselling at an early stage can also improve your general psychological wellbeing and shorten the time it takes you to go back to work or other activities. Your GP or specialist can refer you to counselling services. Psychosexual counselling may also be available for you.

Some solutions

If you are experiencing vaginal discomfort, you can try water-based lubricants and vaginal moisturisers such as Sylk and Yes which are available free on prescription. They can be bought online or from high street stockists. Their oil-based lubricants can be bought online or in the high street.

Avoid lubricants with ingredients such as glycerin, glycols and parabens as these can cause vaginal irritation. Bear in mind not all products list all ingredients, so do a skin patch test first.

It can also help to avoid tight clothing and to wear underwear made from breathable fabrics such as cotton.

Extra help

You can speak to:

• Your gynaecology or oncology nurse specialist
• Your consultant and their medical team
• Your GP

If you need more help, you can see a doctor working in psychosexual medicine, a counsellor or a menopause specialist.

Further resources               

Institute of Psychosexual Medicine 020 7580 0631

College of Sexual and Relationship Therapists (COSRT), this is an organisation for therapists specialising in sexuality and relationships. It has a directory of therapists and information on sex after cancer.

Relate is the largest provider of relationship support in England and Wales. They help people of all ages, backgrounds, sexual orientations and gender identities to strengthen their relationships.

Jo Divine is a company that sells lubricants, moisturisers and sex toys and provides information about sex.

Unexpired Pleasures is a creative documentary film exploring how women’s experiences of cancer intersects with their relationship to sexual pleasure and intimacy.

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We welcome your feedback. If you have any comments or suggestions, please email r.grigg@ovacome.org.uk or call 0207 299 6653.