Rebuilding Your Sex Life After Ovarian Cancer
When a medical condition and its treatment change your body, reconnecting with your sexuality, or allowing it to exist at all, is a trial.
Nevertheless, it is a fight worth tackling because reigniting sexual pleasure can be a transformative healing experience.
Ovarian cancer is the second-most common gynecological cancer in the United States, according to the Centers for Disease Control and Prevention (CDC).
While rare, ovarian cancer accounts for more deaths than any other cancer of the female reproductive system and ranks fifth in overall cancer deaths in women. The chances of developing ovarian cancer during a woman's lifetime are about 1 in 78, as reported by the American Cancer Society (ACS).
What is ovarian cancer?
The ovaries are a pair of female glands where eggs form and are released. They also produce estrogen and progesterone hormones, play an important role in body development, and are central to pregnancy, fertility and the menstrual cycle.
Due to typically being asymptomatic in the early stages, ovarian cancer often goes undetected until it has spread to the pelvis and stomach. Late-stage ovarian cancer is harder to treat and more likely to be fatal. As a result, ovarian cancer is considered the deadliest of all gynecological cancers.
Rates of diagnosis have been steadily falling over the past 20 years. In 2022, about 19,880 women were expected to be diagnosed with ovarian cancer and 12,810 women were expected to die from it, according to ACS estimates.
Symptoms, diagnosis and treatment
"Ovarian cancer is often asymptomatic in early stages and, therefore, often not found until more advanced," explained Clare Bertucio, M.D., a radiation oncologist and CEO of Medicine Mama's Apothecary in Laguna Beach, California. "Symptoms may include abdominal bloating, feeling full early in eating, weight loss, pelvic pain/discomfort, fatigue, change in bowel habits and/or frequent urination."
As these symptoms are also associated with common maladies such as irritable bowel syndrome (IBS) and period pain, diagnosing ovarian cancer can be delayed by the need to eliminate other possibilities.
Ovarian cancer mainly develops in older women. The ACS states that approximately half of the women diagnosed with ovarian cancer are 63 years old or older. This type of gynecological cancer is more common among white women than Black women.
Other risk factors associated with developing ovarian cancer include a family history of it, hormone replacement therapy, never having been pregnant, early onset of menses and/or late onset of menopause and a history of endometriosis.
If a physician suspects ovarian cancer, two tests are most commonly used to screen for it. The first is a transvaginal ultrasound (TVUS) and the second is a blood test.
The TVUS uses sound waves emitted from an ultrasound wand inserted into the vagina to study the fallopian tubes, uterus and ovaries. The blood test screens for a protein called CA-125, of which many ovarian cancer patients have high levels. As the level typically reduces if treatment is working, this blood test is often used as a tumor marker to guide and monitor treatment.
However, high levels of CA-125 are also common in people with pelvic inflammatory disease (PID) and endometriosis, and not everyone who has ovarian cancer has an abnormal level of CA-125.
If ovarian cancer is diagnosed in its earlier stages, it has a higher survival rate. Between 2011 and 2017, average survival rates for five years after diagnosis were 49.1 percent, according to Ovarian Cancer Research Alliance.
After diagnosis, ovarian cancer is typically treated with surgery, as Bertucio outlined.
"Depending on the stage/extent of disease at diagnosis, the type of surgical intervention needed may differ," she said. "Chemotherapy is often required, again, stage dependent. There are certain situations in which immunotherapy may be effective, and for tumors that appear to be estrogen-driven, hormone therapy—blockade of estrogen—may be considered."
A key element to early diagnosis is understanding your body. Pay attention and keep notes about any concerning symptoms or patterns that crop up.
"I advise all women to keep regular checkup schedules with their healthcare providers and to stay in tune with their bodies," Bertucio said. "If you know your body, you will know when a change occurs and be able to seek medical intervention at the earliest onset."
Measuring the impact
"Depending on the stage and extent of treatment necessary, gynecological function will be accordingly impaired," Bertucio said. "As ovarian cancer is often diagnosed at a later stage, women may lose the ability to become pregnant and may be put into menopause, as the surgery for more advanced disease requires removing ovaries, fallopian tubes, uterus and nearby lymph nodes."
Chemotherapy can impact fertility by causing the ovaries to stop releasing eggs and estrogen. This is called primary ovarian insufficiency and is sometimes temporary, however, your medical team can discuss options to preserve fertility before beginning treatment.
As with all types of cancer, ovarian cancer and its treatment may have an impact on sexual function, Bertucio explained.
"Vulvar and vaginal dryness, shortened vaginal length and altered self-image can all play a role in sexual dysfunction following treatment for ovarian cancer," she said. "Each woman should be counseled and supported on an individual basis by the full team of treating professionals."
As with all types of long-term illness, ovarian cancer can have a devastating psychological impact, and retaining a strong support system is crucial.
"I strongly encourage all of those involved to seek support and counsel as needed; they are not alone, and there is a team of highly trained professionals at the ready to step in and help," Bertucio said. "Sometimes just asking for help is the hardest part, but it can make a difference."
Reengaging your sexuality
Consult your physicians before reentering the world of sex. They can help determine the right time to engage in sex again and ensure that sexual activity will not cause harm.
Next, rediscovering your body solo before introducing partnered sex is a helpful step. Identify and measure any bodily changes, such as altered sensations, to determine how they have impacted your desires, sensations or emotional connection to sex.
Masturbating in your favorite sex positions can help eliminate any positions that are now uncomfortable or more difficult to achieve with a partner.
Identify and break down any emotional blocks so you can deal with them one at a time. Speaking with a counselor throughout this process can make the process more seamless.
Do not be afraid to recruit aids, such as liberally applying lubricants, to make playing easier, advised Amy Pilotte, M.S.N., a senior oncology advanced practice provider in Portsmouth, Rhode Island.
"Use of a silicone vaginal dilator can be very helpful and is important after some surgeries and radiation therapy," she explained. "Many patients will benefit from seeing a physical therapist who is trained in pelvic floor therapy. Patients should regularly use a vaginal moisturizer at least three times a week to help moisturize the vaginal lining. Over-the-counter moisturizers like organic coconut oil and jojoba oil can be helpful."
Tools, experimentation and self-exploration are all keys to reigniting the sexual flame after ovarian cancer, but the most influential element is communication. Share how ovarian cancer has affected you mentally, physically and sexually.
Do not push yourself beyond the point of comfort to pleasure someone else; being selfish during this time can protect you from any pain and discomfort. Prioritize your own orgasmic satisfaction and take one small step at a time. There is no rush. Your sex life will fly free again, regardless of how ovarian cancer tried to block it.