Your body image and sexuality

Your body image

Dealing with an altered body image and changes in your sexuality can be difficult for younger women. Most women will experience changes. Some changes will be treatment induced and possibly short-term, but some women will have long-term effects. The feeling you experience may have been unexpected. They can leave you feeling unsure of where to seek help and possibly embarrassed to talk about it. You’re not alone; many women in your situation experience similar feelings and help is available.  

Body image

Changes you may experience

Some women experience a loss of self-esteem and confidence. Surgery can cause a number of different physical changes including scars, pains, hormonal changes and menopause, loss of fertility and sometimes the need of a stoma (a surgically created opening on your abdomen to allow waste to exit the body). Chemotherapy can cause hair loss, fatigue, tiredness and nausea or vomiting.

All these factors can have an impact on how you feel about yourself and may have an impact on your relationships with family, friends and intimate partners and you may find that you question who you are now.

“I felt really disconnected from my body, I think I didn’t feel at all confident naked. Since then I’ve managed to sit by a swimming pool in a swimming costume. It’s not that I feel self-conscious that people are looking at me – but bits of my body remind me of what happened. But it is improving and the scars are fading.”

Sarah, diagnosed aged 40
What can I do?

Coming to terms with the new you will take time. For some women it takes weeks and for others months or even longer. Give yourself time to adjust to your new normal.

  • Before treatment, talk to your medical team about what body changes to expect so that you can prepare yourself.
  • Be prepared for relatives and friends to ask questions about your treatment, and for questions or comments about your appearance. Having thought about how you will respond will make it easier. If you prefer not to talk about it, let people know.
  • Healthy lifestyle changes such as exercise, good nutrition, meditation and complementary therapies such as aromatherapy, reflexology, acupuncture or massage can help you to feel better and manage stress.
  • It may help to write about your feelings, or talk about them with a trusted person.

Sexuality

Sexuality is not just about intercourse or masturbation, it’s about how you feel about yourself, how you interact in relationships and your physical responses in sexual situations. It’s an important aspect of body image, and can be affected by your diagnosis and treatment.

Changes you may experience

Lower sex drive

The loss of testosterone (a hormone produced by men and women) after a surgical menopause may affect your sex drive. You can talk to your GP about hormone replacement therapy (HRT) for this. Your sex drive is dependent not just on your hormones but also on your general well-being, satisfaction with relationships, stress, tiredness and self-esteem. You or your partner may experience low desire due to the range of emotions you are both dealing with in order to come to terms with your diagnosis. You may find sex no longer gives you pleasure, or is painful, and this may affect your sex drive.

Vaginal dryness and painful sex

After a surgical menopause, the changes in your oestrogen levels cause changes to your vagina and the tissues surrounding it. The vagina may not be as moist as it previously was and lubrication can be a problem. This can make sex painful and cause vaginal itching and dryness. This is very common but easy to treat.

Due to hormonal changes some women feel differently about sex after the menopause, and their arousal and orgasm may not be the same as before. Some women develop internal scaring and adhesions that may cause pain each time they have sex. Not being sufficiently aroused can also lead to painful sex and vice versa; painful sex can lead to a loss of arousal. 

It’s normal to go off sex at times. Knowing why things may be different might help you to understand your personal experiences and highlight if you are having difficulties you’d like help with. 

What can I do?

Communication is important. Discussing your worries and fears, or what hurts during sex will help you to work out a solution.

  • Be open and honest with yourself and your partner. This will help you feel more relaxed and resolve any problems. Ask your partner what they are concerned about too. Talking to each other can deepen your relationship and have a positive effect on intimacy. For instance you may decide to avoid sex for a while but concentrate on kissing and cuddling, or you may try longer foreplay and different positions.
  • Your CNS can advise you or refer you to a sexual health specialist. Don’t be shy about talking to a professional about it; they will want to help you with this aspect of your recovery.
  • Take your time. Painful sex can prevent some women from experiencing an orgasm. It may be that sex is only painful when first having intercourse following surgery and it will settle as your body recovers.
  • Lubricants can improve sensation and moistness. Non hormonal vaginal moisturisers are available to relieve symptoms and vaginally applied oestrogen may be offered as a long-term treatment. It’s worth exploring this with your CNS.
  • Hormones are important in sexual desire and response. For some women HRT may help so speak to your CNS or GP about your options.
  • Be kind and pamper yourself. Looking after yourself can help build your self-image back up.