Your body image and sexuality
Dealing with an altered body image and changes in your sexuality can be particularly difficult for younger people.
The feelings you experience may be unexpected. They can leave you feeling unsure of where to seek help and possibly embarrassed to talk about it. You’re not alone; many others in your situation experience similar feelings and help is available.
Body image
Changes you may experience
Some people 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 for a stoma (a surgically created opening on your abdomen to allow waste (poo) 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. You may find that you question who you are now.
"I got to the stage where my hair didn’t define me. I got more confident in myself walking around without a head scarf on at home or when I went round to my neighbours and they got used to it."
Amanda, diagnosed aged 41
What can I do?
Coming to terms with the new you will take time. For some, 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 thoughts 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, a balanced diet, 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 and your relationship with intimate partners
Dating and new relationships
Dating after a cancer diagnosis can feel overwhelming. The thought of having to tell new people about your diagnosis puts a pressure on dating that wasn’t there before. Only start dating when you feel ready to, in a way that suits you.
If you’re trying internet dating or apps, you might decide to put it on your dating profile from the start, or you might want to discuss it via messaging before you meet anyone in person. However, do bear in mind that a person's online version of themselves can often be different to reality. You may decide not to tell anyone about your diagnosis unless you are in a committed relationship. It is entirely up to you.
Speed dating can be a way to get used to talking to new people in an unpressured way, and you can go along with friends for fun and support. It may be tiring though, and it’s worth thinking about activities on dates if you find you become tired more quickly after treatment. Think about suggesting meeting where you can pace yourself if needed, such as bars and restaurants that have good seating available. You might want to start with something more relaxed like a coffee date, or an activity that gives you the opportunity to leave if you feel overwhelmed or tired.
Don’t feel pressured to say or do anything that you don’t want to. You can tell someone about your cancer diagnosis if and when you feel comfortable to do so, and this will be different with different people.
Long term relationships
Your partner will have been affected by your diagnosis and treatment. Talking about how you both feel, sharing your fears or worries and your hopes for the future can help. You may find that going through this experience and talking about how you feel brings you closer together but it can also test relationships to their limits.
Exploring your sex life after treatment can be a time to try different things if what suits your body or mind has changed since diagnosis. For example, you may not want to have penetrative sex.
Your sex life may change but it can still be fulfilling for you and your partner. Being able to talk about these changes openly can be really helpful.
Psychological and emotional effects
You may experience changes in the way you feel about your body or how you find yourself responding to your partner. The emotions experienced throughout cancer treatment and beyond can affect how you feel about your body image, your attractiveness and sexuality.
"I guess if you don’t like talking about sex but you do like having it, you’ll have questions that need to be answered. It’ll be better if you just ask."
Lisa, diagnosed aged 21
What helps with these feelings varies from person to person. You could think about massage, makeovers and relaxation techniques to help put you back in touch with your body and improve your general wellbeing and self-esteem. Looking after yourself will help build your self-image and feeling of self-worth.
It often helps to know how others feel after their cancer treatments, so going to a support group and discovering others' experiences can be useful.
You can also have more in-depth psychosexual counselling, and your medical team or GP can refer you for this.
Sex and intimacy
How you express your sexuality is very personal and unique to you. It is not fixed, and changes over time for everyone. A cancer diagnosis can affect your sexuality as you cope with physical and psychological changes.
Remember, the brain has a huge role to play in sexual desire and responses. After a big life event your mind might not be ready to consider physical and emotional intimacy.
It is important to feel comfortable and confident with your own feelings, needs and desires. Exploring these will help you talk to your intimate partners about how you may have changed since your treatment. For example, you may not want your surgery scar touched if it is very sensitive. You may decide to avoid sex for a while but concentrate on kissing and cuddling, or you may try longer foreplay and different positions.
Do remember that even if you have been through the menopause as a result of your ovarian cancer treatment and can no longer get pregnant, it is still important to use condoms and get tested to avoid STIs (sexually transmitted infections). The thinning walls of the vagina and vulva after menopause can increase your risk of transmission through penetrative sex, sharing sex toys, and oral sex.
Physical effects
Ovarian cancer can result in significant physical changes to your body, which can change your sex life. However, this doesn’t mean you can’t have satisfying sexual experiences.
Some people don't experience these changes at all.
After a surgical menopause, the changes in your oestrogen levels cause changes to your vagina and the tissues surrounding it.
Your vagina may not be as moist as it previously was and may not lubricate itself as easily when you are turned on. This can make sex painful and cause vaginal itching and dryness. This is very common but easy to treat.
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 also be bought online or on the high street. Their oil-based lubricants can also be bought online or on the high street.
It is advisable to 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.
Surgery may shorten your vagina. If you have had radiotherapy, you may find that you have reduced space and lubrication in your vagina. You can try sexual positions where you control the depth of penetration. Toys such as the OhNut are also helpful in controlling how deep penetration is, by acting as a soft buffer.
Vaginal dilators can help with excessive scarring or shortening of the vagina and your team can provide these and advise you how to use them. Using a slim sex toy as an alternative to dilators is something some people prefer to do as it feels less clinical and offers a good 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. This can also be a simple way to step back into enjoying sex and can be fun to use alone or with a partner.
For some people, dilation therapy may be triggering or upsetting, especially if you are not used to having anything in your vagina for any reason. If you struggle with dilation therapy, talk to your clinical nurse specialist or other keyworker. They are there to support you.
Vaginally applied oestrogen may be offered as a long-term treatment for vaginal dryness and also urinary symptoms. It’s worth exploring this with your CNS.
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 and vice versa. Painful sex can lead to loss of arousal.
Taking time to work out what suits you now, allowing time to become aroused, sharing this with a partner and talking to your team about any pain you are experiencing and how this can be managed, can all help. Exploring masturbation and oral sex with a partner can allow you to experience sexual pleasure without penetration.
It may be that sex is only painful when first having intercourse following surgery and it will settle as your body recovers. Take your time.
It’s normal to not want sex at times. Knowing why things may be different might help you to understand what is happening and seek support if needed.
Your sex drive is dependent not just on your hormones but also on your general wellbeing and satisfaction within relationships. Stress, tiredness and self-esteem also affect your sexual responses. You or your partner may experience low desire due to the range of emotions you are both dealing with as you both come to terms with your diagnosis.
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.
If you experience lower sex drive, make sure you take your time. Maintaining good communication and physical touch with partners can help to sustain closeness until you feel ready to progress.
Due to hormonal changes some people feel differently about sex after the menopause, and their arousal and orgasm may not be the same as before. Your orgasms may feel different if you have had a hysterectomy (had your womb and cervix removed).
If you have previously found that some of your pleasure during orgasm centred on your womb contracting, you may find your orgasms feel quite different. However, you can still feel your orgasms through your clitoris or vagina. If you enjoy the sensation of your cervix being touched during sex, this will feel different if it has been removed.
These changes to orgasm can feel like yet another loss caused by cancer. Taking time to work out what arouses you now and how your body responds can help you find new ways of experiencing pleasure.
Masturbation is a way to experience sexual pleasure on your own and can help with understanding your sexual responses after treatment. It can be a good opportunity to practice your mind-body connection, helping your brain and body to remember how you experience sexual pleasure.
You may want to explore sex toys. These can help with vaginal tightness and decreased sensation. If so, 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 but remember silicone lubricants are not suitable with silicone sex toys, which will need a water-based lubricant.
