Ovarian cancer and its treatment can make resuming intimacy with a partner challenging. Many of the therapies used to treat ovarian cancer can affect a woman’s sex organs, sexual desire, sexual function, and body image, according to the American Cancer Society. One study, published in 2017 in the International Journal of Gynecological Cancer, found that between 50 and 70 percent of women with gynecologic cancers experienced sexual dysfunction after treatment. “In many cases, these intimacy issues led to marital difficulties, including separation and divorce,” explains the lead author Saketh R. Guntupalli, MD, who wrote about his findings in his book Sex and Cancer: Intimacy, Romance, and Love After Diagnosis and Treatment. Adding to the problem: Doctors don’t always discuss the sexual impact of treatments or raise the topic of sexuality at follow-up visits. “Studies show that less than 10 percent of physicians bring up the idea of sexual intimacy after the diagnosis of cancer, even though a lot of patients want their physicians to talk about it,” notes Guntupalli. “As a group we need to be doing a much better job of letting women know what they may experience and what they can do to overcome these issues.”
What Sexual Side Effects Can You Expect?
Sexual dysfunction can result from the physical effects of ovarian cancer therapies, as well as the psychological effects of diagnosis and treatment. Which side effects you experience will depend on your age, stage of ovarian cancer, and the treatments you receive. The most commonly reported side effects among women being treated for ovarian cancer include:
Loss of desire for sexual activityDissatisfaction with sexual activityDifficulty achieving orgasmVaginal soreness and drynessShortening of the vaginaPain during sexual intercourse
Which Treatments for Ovarian Cancer Can Cause Sexual Side Effects?
The following treatments are most likely to affect sexual function.
Surgery
Treating ovarian cancer typically involves removal of the ovaries (bilateral oophorectomy). If you’re premenopausal, losing your ovaries will result in a significant drop in estrogen levels, which can lessen libido. “If you don’t have estrogen, then estrogen can’t get converted to testosterone, which is what drives sexual desire in women,” explains Guntupalli. Low estrogen levels can also cause the lining of the vagina to become thinner, dryer, and less stretchable. In some women, the vagina may stay tight and dry, even if they are very aroused, according to the American Cancer Society. While these effects are most dramatic for premenopausal women, post-menopausal women may also experience sexual changes. “That’s because the ovaries continue to produce some estrogen even after menopause,” Guntupalli notes. Surgery to treat ovarian cancer may also include removal of the fallopian tubes and uterus (hysterectomy), which can shorten the vagina and cause some scarring at the top of the vagina. This can sometimes make intercourse painful. RELATED: 6 Ways to Ease Painful Sex During and After Menopause
Chemotherapy
For younger women who may opt to keep one ovary intact after surgery, chemotherapy can cause that ovary to temporarily, or permanently, stop producing estrogen, which can result in decreased libido, thinning of the vaginal lining, and vaginal dryness. Some chemotherapy drugs that irritate the mouth can also affect the all the mucous membranes in the body, including the vagina, causing it to become dry and inflamed. Other side effects of chemotherapy — such as fatigue, nausea, hair loss, and weight gain or loss — can lower self-esteem and lessen interest in, and energy for, sex. RELATED: 8 Ways to Fight the Fatigue of Chemotherapy Treatment
Targeted Therapies
Some of the targeted therapies used for ovarian cancer (such as angiogenesis inhibitors) can cause inflammation and soreness of the vaginal lining and lead to discomfort during sex.
Hormone Therapy
Hormonal treatments, such as aromatase inhibitors, work to turn off estrogen production. This can inhibit libido, cause vaginal dryness, and make sex feel more uncomfortable.
Intimacy After Ovarian Cancer: How to Find a New Normal
The good news is that there is sex after ovarian cancer. While your sex life might look and feel different from your precancer days, there are ways to maintain intimacy both during and after treatment.
Talk to Your Team
While it may feel awkward, it’s very important that you talk to your doctor about what sexual side effects you can expect, and continue to talk about what’s changing or has changed in your sexual life as you go through procedures, treatments, and follow-up care. If you don’t feel comfortable speaking with your oncologist about intimacy issues, find someone else on your cancer team whom you trust, such as a nurse, social worker, or counselor.
Be Honest With Your Partner
Sometimes just acknowledging that things are different and that you want to talk about it can take a huge weight off both of you. These conversations work best when they take place in a neutral, nonthreatening space, like on a walk, rather than in the bedroom right before you go to sleep.
Broaden Your Definition of Sex
There may be times during and after cancer treatment when the kind of sex you like best is not possible. Those times can actually be an opportunity to explore new ways to give and receive sexual pleasure, or to simply spend time talking, cuddling, or caressing. “Sexual intimacy is a spectrum,” notes Guntupalli. “Sometimes sexual intimacy is oral sex. Sometimes it’s touching. Sometimes it’s just going for a walk.” RELATED: What Is the Role of Intimacy and Sex in Your Overall Health?
Get a Great Lubricant
Vaginal dryness and atrophy caused by cancer treatments can make intercourse painful. “Using a good lubricant can make a huge difference,” says Guntupalli. He recommends getting a high-end, water-based, unscented lube that has a long-lasting glide and isn’t watery feeling or sticky. You may also want to talk to your gynecologist about using an over-the-counter vaginal moisturizer several times a week. Vaginal moisturizers are designed to help keep your vagina moist and at a more normal acid balance (pH) for a few days. For some women, using a topical estrogen cream (only available by prescription) can also help.
Boost Your Self-Worth
Do whatever you can to feel good about yourself, whether it’s getting a great wig, wearing nice clothes or sexy lingerie, or eating right and exercising. Living the life you want and deserve will help make you feel more attractive to your partner and to yourself. RELATED: Better Sex: How to Enhance Intimate Sexual Experiences
Connect With Survivors
“Your doctor can point you in the right direction, but only another survivor will understand exactly what you’re going through,” stresses Guntupalli. Ask your cancer team if they can connect you with a support group in your area. You can also find out about local and online ovarian cancer groups through the American Cancer Society and the National Ovarian Cancer Coalition.
Get Help
If you continue to struggle with desire, sexual pain, or any other intimacy issues, ask your healthcare provider for a referral to a couple’s counselor or sex therapist. Your doctor may also be able to refer you to a special therapist for pelvic physical therapy (also known as pelvic rehabilitation). This type of therapy can help you recover from treatment, relax your vaginal muscles, and regain comfort and pleasure during intercourse.
