Dealing with an altered body image and changes in your sexuality can be particularly difficult for younger women. You may also be concerned about ovarian cancer and the impact that resulting treatment may have on your fertility. This information provides advice on sex, intimacy and your fertility.
Body image and intimacy
Dealing with an altered body image and changes in your sexuality can be particularly difficult for younger women. Some changes will be treatment-induced and possibly short-term, but some women will have long-term effects.
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.
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 women in your situation experience similar feelings and help is available.
Changes you may experience
Loss of self-esteem and confidence
Surgery can cause a number of different physical changes including scars, hormonal changes and sometimes the need of a stoma. 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.
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. You or your partner may also experience low desire due to the range of emotions you're 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. Your 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. Not being sufficiently aroused can also lead to painful sex and vice versa; painful sex can lead to 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're having difficulties you'd like help with.
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.
- 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.
- Be open and honest with yourself and your partner. This will help you feel more relaxed and more able to resolve any problems. Ask your partner what they're 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 clinical nurse specialist (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.
- Be kind and pamper yourself. Looking after yourself can help build your self-image back up.
Listen to our 'Ovarian cancer, sex and intimacy' podcast or read the transcript [PDF], where we answer your questions, talk about what physical and emotional issues you may face and discuss how you can seek help and support.
Having ovarian cancer and the resulting treatment can affect your fertility.
You may be single or in a relationship. You may not be sure if you want children in the future, or you may be diagnosed just at the age when you were planning to start a family. This can make ovarian cancer even harder to cope with.
Your treatment and fertility
Ovarian cancer treatment may result in the removal of both ovaries and fallopian tubes, and the uterus (womb). This means you won't be able to become pregnant naturally but you may still have other options.
If the cancer is caught early, with only one ovary involved, or if you have a germ cell tumour of the ovary, it might be possible to preserve the uterus and the unaffected ovary may remain fertile.
However, chemotherapy may damage your remaining ovary or increase your risk of an earlier menopause.
Talking about fertility
The main priority for your treatment is to save your life. It's important to talk about your fertility needs before treatment starts in order to help you, your partner and your medical team plan the most appropriate treatment for you while being realistic about your prospects of remaining fertile.
However, this may not be possible, for example, if treatment has to start immediately or you've been diagnosed through emergency surgery, in which case you may want to talk about your options after the treatment when you feel ready.
Your CNS or consultant can advise whether to seek further fertility counselling and provide referral letters for your GP and other fertility services.
A discussion about your fertility and treatment options should include:
- a discussion about adjusting treatment to preserve fertility
- a realistic assessment of your chances of getting pregnant post-treatment
- a full and honest discussion about the impact of cancer on your life
- thoughts about the impact on any children you may have or plan to have, and on your partner if your cancer treatment does not prolong your life
- options for fertility treatment, including the costs if you choose to fund this privately.
In vitro fertilisation (IVF)
If you did not have a total hysterectomy as part of your treatment it may be possible for you to explore IVF.
IVF is the process in which eggs are fertilised by sperm (from your partner or a donor) and then placed into your womb. Depending on your diagnosis it may have been possible to harvest eggs before your treatment starts, but it may not always be possible to delay treatment to do so. In this case you can still use a donor egg.
The NHS will cover the cost for some IVF. Speak to your CNS or consultant, who can support you to get a referral from your GP. If you're not eligible for NHS funding or you decide to pay for IVF you can contact a private clinic. Private fertility treatment costs vary across the UK.
The Human Fertilisation and Embryology Authority (HFEA) regulates and licenses fertility clinics. You can find out more about IVF techniques, how long treatment may take, how to find a clinic and the costs on their website. Most fertility centres advise that you wait for two years after treatment ends before trying to have a baby.
If you had a total hysterectomy with your uterus and ovaries removed, or after discussions with your partner, family and cancer team (and possibly a fertility specialist) you decide IVF is not a realistic option for you, you may want to consider other options for having a child.
Surrogacy is where another woman (the surrogate) carries your baby through pregnancy for you.
Traditional or partial surrogacy is where your partner or a donor’s sperm is placed in the surrogate's vagina. This is usually done by artificial insemination and can be done in a clinic or with an insemination kit at home.
Host (or full) surrogacy is when an embryo created from your partner or a donor's sperm and an egg previously harvested from you or a donor is placed inside the uterus of your surrogate. This type is much more complicated than traditional surrogacy.
The legality and costs of surrogacy are complicated. Surrogacy UK provides comprehensive and accurate information.
Adoption and fostering
Through adoption you would assume the parenting of a child from that child's biological or legal parent(s). All rights and responsibilities are transferred permanently to the adopting parents.
Fostering is a way of providing a home for a child at times when they are unable to live with their birth family. This includes providing care in emergencies and for longer periods. The child will remain in touch with their biological family and hopefully will return home. Although most adoption agencies allow cancer survivors to adopt, some require a letter from a doctor certifying good health, and others may require a certain amount of time to pass after you have completed treatment for cancer.
You can visit CoramBAAF Adoption and Fostering Academy for more information.
If you decide not to have children
Being unable to have children naturally can be very difficult to deal with. However, you might not have wanted children in the first place or, after having discussed fertility options with your partner, family, and professionals, you may choose to enjoy life without having children.
Coping with your emotions
It may not be until after your treatment has finished that you have the time and ability to process your feelings. You might find that any relief related to finishing treatment is replaced by anger or grief at not being able to become a parent. You may feel isolated and unable to share your emotions with your partner and your family. Some women find it hard to feel joy for friends and family who can have children and this might make them feel guilty. This may put a strain on your relationships but it's important to share these feelings rather than keeping them to yourself.
You may find it helpful to speak to a professional counsellor, who will provide you with a safe and non-judgmental space to explore your feelings.
This information is reviewed regularly and is in line with accepted national and international guidelines. All of our publications undergo an expert peer review and are reviewed by women with ovarian cancer to ensure that we provide accurate and high-quality information. To find out more take a look at our information standards.