Body Image and Intimacy After Ovarian Cancer

Yes. Treatments such as surgery, chemotherapy, and hormone therapy can lead to changes in libido, vaginal dryness, pain during intercourse, and altered body image. These physical and emotional changes can affect intimacy and sexual well-being for survivors.

Rebuilding intimacy starts with communication and patience. Small steps, such as sending a thoughtful note, scheduling date nights without “cancer talk,” or trying gentle physical touch, can help restore closeness. Counseling with a clinical sexologist or couples therapist can also provide guidance.

Survivors often benefit from reframing scars as “battle wounds,” exploring movement or exercise in their new body, wearing clothing that feels comfortable, and practicing positive self-talk. Humor, creativity, and self-compassion also play a key role.

If your healthcare provider is unsure or uncomfortable discussing sexual health, ask for a referral to a clinical sexologist, behavioral health specialist, or pelvic health physical therapist. There are many evidence-based solutions to improve sexual well-being for survivors.

Yes. While ovarian cancer treatment can cause lasting physical changes, survivors can still experience a fulfilling sex life. Healing may take time, but with self-advocacy, communication, and support, it is possible to rebuild sexual health and intimacy.

Stefanie Taylor: Hello everyone. I’m Stephanie Taylor, today’s conversation touches on a deeply personal and often overlooked aspect of the cancer experience. I’m honored to be joined by Alexandria Callahan, a clinical sexologist and behavioral health manager, from City of Hope.

Stefanie Taylor: Thank you so much and we really appreciate you taking your time to share your expertise with us today.

Stefanie Taylor: Alexandria. We often hear about body image concerns after surgery. Can you please share how physical changes can impact someone emotionally and change how they see themselves? 

Alexandria: So there’s so many physical changes that happen and a lot of times, you look in the mirror [00:01:00] and you don’t recognize that person in front of you.

Alexandria: Besides like the hair loss, skin pigmentation can change. I have a lot of patients that have said, I didn’t realize that, my hands are gonna get darker. They’re lighter. My skin’s blotchy. Now there’s that weight gain or loss. Muscle tone shifts. Even having scars from surgeries and procedures and, we don’t really think about all of those things.

Alexandria: You think, okay, I’m going through chemo, I’m gonna lose my hair. But the impact of it can be so detrimental for patients and even that weight gain or loss. A lot of times you. I’ve had patients that have joked around about this isn’t the diet I wanted to go on, but now I’m losing weight and I can fit into those clothes I used to wear in high school.

Alexandria: On the flip side though, I’ve had some patients say, I’ve been a size 12 my entire life and now I’ve lost weight and I don’t fit into my favorite clothes. I don’t feel confident in my body anymore. So it’s interesting too to see how that weight loss for some people can be, amazing. And others are like, Nope, this doesn’t work for me.

Alexandria: And then the other way too, if they’re on any kind of [00:02:00] steroid and they’re gaining weight, they’re looking at themselves saying, okay, I’ve lost my hair. The, all these other things are changing and now I’m gaining weight. I can’t even wear my favorite clothes. I have to wear sweatpants now.

Alexandria: And although they’re comfortable, like I just, I don’t want to. Go out into public like that, and that takes a huge emotional toll on people, especially when they are viewing themselves as a stranger. They don’t know their body anymore. They, things don’t feel as good. They’re not feeling as sexy or attractive.

Alexandria: A lot of the women won’t let their, partners touch them anymore. They said, I don’t feel good about myself. I don’t want them touching me. And it takes a lot of work just in those conversations to help them find that confidence, to find some beauty within themselves and definitely letting go.

Alexandria: A lot of that negative self-talk that they have. 

Stefanie Taylor: That negative self-talk can really be overpowering, overwhelming. And you talked a lot about self-confidence. Some survivors have shared that they feel that they disconnect from that part [00:03:00] of their body and those images

Stefanie Taylor: so how do we begin to redefine beauty and sexuality after treatment? 

Alexandria: That’s an excellent question. You know what, it is interesting too. As I was, working with patients outta curiosity, I was like, oh, let me see what, the world thinks of beauty and sexuality.

Alexandria: And I was shocked. So when you do a Google image search of beauty, all these different makeup products come up and when you do a search of sexy, you get very busty women wearing. Revealing clothing that doesn’t leave much up to the imagination or the pictures are censored, at least our company censored them, so I can only imagine what they are.

Alexandria: And if you think about. You’re going through a cancer treatment and your body’s shifting and changing, and you see all of these different images in your face, and that’s what beauty and sexuality are supposed to look like. It can be really disconcerting, and I think that plays into that negative self-talk too.

Alexandria: So being able to look at [00:04:00] yourself in the mirror and, think about the story that you’re telling yourself about you is very important to you, because we write our own scripts. So if you’re looking at yourself every day saying, oh, you’re ugly. You don’t have that perfect body anymore.

Alexandria: You know you have all these scars, no one’s gonna find you attractive. You’re gonna start believing that and that’s gonna be become your story, your truth. And those are all learned behaviors. So it’s learning to unlearn those and say, okay, I’ve gone through this incredible journey. I’m on the other side.

Alexandria: I’m a survivor. Especially with ovarian cancer, like the survivor rate, like we praise that especially when, you get to the other side and you’re saying, okay, I’ve made it through that hardest part. And I have an inner strength that other people don’t have. They didn’t go through this fight.

Alexandria: They didn’t have that fear of mortality. I think we go through life thinking, burn invincible, and then something like this happens and you’re just like, whoa, okay. There is something that can actually harm my body. So it is being able [00:05:00] to boost that confidence and explore what it feels like to move in this new body.

Alexandria: How do you connect to it? I think movement is an amazing way to even just start to ground yourself and get that reconnection and say, okay . My arms are moving differently. I had this huge abdominal surgery, so the things that, I used to feel supported in, I have to work at a little bit more.

Alexandria: And that can be a fun experiment too, to say, okay how is my body moving and what does it look like now after these surgeries and things? I’ve had some patients say, they look at their scars as their battle wounds, and it’s almost like a shield of pride for them.

Alexandria: I made it through, I’ve got this battle wound to prove it. No I’m gonna go want it had one patient. She’s yep, I’m wearing the bikini. I want everyone to see the fight that I went through in that way. So it is figuring out, how you’re presenting yourself. What clothing makes you feel good, especially as you’re going through treatments and looking at the way you interact with people.

Stefanie Taylor: It’s about, once again, [00:06:00] recognizing your own self-worth, being a little bit gracious and kind to yourself about the changes that did occur and some great tips that you did share. So thank you for that. Alexandria, unfortunately, many people feel too embarrassed or ashamed to bring up these issues with their providers. Why do you think that is? 

Alexandria: There’s definitely a lot of stigma around sex and sexuality and sexual health as being a taboo subject. And you even too, there’s a lot of religious and cultural views on sex and sexuality, so it’s not as clear cut as I’m going into the doctor’s office with pain,

Alexandria: the doctors are like, all right, pain, we know what to do. We’ll send you the pain team, or, here we’ll give you a, the prescription to help with that. With the sexual health piece though, there’s, an embarrassment piece in there. If your providers aren’t a hundred percent comfortable talking about it, they tend to not bring it up and if the patient is embarrassed or.

Alexandria: Scared to bring something up or thinks that, there’s something wrong with [00:07:00] me, then it’s just not being talked about. And that’s the unfortunate piece and definitely a disservice, especially when you’re dealing with, ovarian cancer. We’re right there in one of the, those main areas that, is part of that sexual health and wellbeing.

Alexandria: So it’s definitely, making sure that you are bringing it to the healthcare providers or, the providers themselves are initiating some of that conversation and even sending those referrals. What’s great here with City of Hope, we have our physicians, they know that there’s a sexual health team, so even if they’re not comfortable talking about it, they’re like, oh, we know who can talk to you about this.

Alexandria: So it’s, getting those conversations happening though. And we’ve had a lot of patients that have reported, if their provider doesn’t ask them, then they don’t say anything either because they feel like, oh, it’s not anything I have to worry about, or it gets blown off. I’ve had some patients that they’ve talked with their gynecologist and they’re like, oh, that’s just a symptom of menopause.

Alexandria: It happens to everybody. So it gets. Brushed aside versus there’s something we can do to help you with that.

Stefanie Taylor: And [00:08:00] Alexandria, you bring up such a valid point because it is very.

Stefanie Taylor: Uncomfortable for a lot of women to approach this subject matter with their healthcare providers. And they oftentimes feel dismissed. So they will just internalize everything. What advice then would you give to somebody to help them start that conversation?

Alexandria: it’s really advocating for yourself as a patient.

Alexandria: So asking those direct questions of your providers. If it goes back to the, if you don’t say anything, then there’s not an issue, there’s nothing happening, so then you’re just dealing with it. I really, encourage young patients. To ask for referrals for a specialist in sexual health.

Alexandria: If your provider doesn’t know the answer or seems uncomfortable engaging in the topic, saying, where can I go, who can help me with this piece? And it’s remembering too that there are so many solutions to improve the quality of life. That for a lot of those common sexual health issues that often get overlooked.

Alexandria: So it’s saying, Hey, you know what? I’m having sex [00:09:00] and it’s painful. And yeah, I listened to this podcast and they said Sex should never be painful. So it’s saying, what can we do that and how can I make that? Not be the norm for myself. How can I, go back to reclaiming your body, finding pleasure, that’s, an important thing too.

Alexandria: And something that is often, brushed aside. Just because the focus is on, you gotta get through the cancer treatment. You don’t have to worry about that. You’re not having sex right now. It’s not just about sex, it’s about, the quality of life. And, being able to have that sexual health piece in there.

Stefanie Taylor: You deserve a better quality of life. So let’s shift to the emotional journey.

Stefanie Taylor: Cancer is traumatic. That trauma can linger, can even become paralyzing. How does this impact sexual health and intimacy long term?

Alexandria: So the fight, flight, freeze and fun is a response to trauma.

Alexandria: So I typically give the example, if you’re walking through the woods and a bear comes up to you, some people are gonna freeze. They’re just gonna freak out, and there are a [00:10:00] statue in there and, some are gonna, run. So there’s that flight mechanism. I don’t know many people that will try to fight the bear.

Alexandria: And then, with the Fawn, which is actually newer in research, fawn is more kinda like Stockholm Syndrome where you just give in and you’re working with that stressful situation for as a mode of survival. So when we look at that in return of cancer, we have some people that, they put their boxing gloves on.

Alexandria: They’re like, all right, I’m just pushing through. They’re ignoring all the emotions, ignoring any of the changes. They’re like, I just gotta get through treatment. I’m getting from point A to point B, and that’s it. So those are, our fighters, the flight people go into a denial. They’re just like, all right, you know what I don’t even know if I have cancer.

Alexandria: I’m not even using that word. We’re not acknowledging it. There’s the freezing piece too, where they’re numb. Just emotionally, so they’re going through the motions, almost on autopilot. And then the fun piece, it doesn’t necessarily go into cancer treatments. It’s, I would say that’s more if [00:11:00] you’re like medically naive and you’re just, you’re not asking those questions, you’re not advocating for yourself.

Alexandria: You’re just saying, okay, I’m just trying to survive. So they told me I need to do this, so that’s what I’m gonna do. Versus, having some of that questioning. And a lot of people too are afraid to question or bring things up to their doctors because the doctors are the ones that are essentially there to help save their lives.

Alexandria: And that all happens with the trauma piece too. So we know that trauma impacts your body and your mind and how we cope with things looks very different. For some patients, we’ve noticed an increase in their anxiety or depressive symptoms, and that too will impact your sexual health and intimacy.

Alexandria: If you’re highly anxious or you’re in that survivor mode. Blood is rushing to your brain. Your, the cortisol is just pumping through your system. So the last thing you’re thinking about is, oh, I wanna be intimate, or I feel aroused, or, I have this desire to be with my partner right now because your body is not [00:12:00] there.

Alexandria: And that’s an important thing to recognize too, because if we’re in that constant state of stress. We’re actually doing a disservice to our body. So we talk a lot, and I know we’ll probably talk later too about that self-care piece and the importance in that to help regulate that stress and get us out of that trauma state so that we can be more present with our bodies.

Alexandria: And that way too, it’ll help you be more in tune to the changes that you’re experiencing and whether it’s, the physical changes or just emotional shifts and changes. 

Stefanie Taylor: So there are a lot of emotional struggles that the patient is going through. You talk about the stress affecting intimacy and your relationships. So what else could somebody struggle with in terms of their intimate relationships with their partners because of the emotional changes?

Alexandria: There’s definitely a loss in their identity. If you are a mother or a wife and you’re going through, this treatment and now all of a sudden your spouse, your kids, they’re taking care of you. So you’re switching [00:13:00] that role for being, a caregiver even when you’re.

Alexandria: You are working full-time and you’re not able to work because of treatment. So there’s a lot of changes in those roles, especially with the spousal role. We look at that a lot because, when you’re a patient and you have your spouse as your caregiver, a lot of times we lose that, husband, wife, or wife role relationship, and it’s really important to keep that.

Alexandria: Intact and it can be challenging, especially, if you have a treatment that makes you really sick, and then this person’s like they’re trying to hand feed you or they’re holding your hair that’s as you’re throwing up, or they’re watching your hair as it’s falling out. And that emotional toll that it takes.

Alexandria: So it is really, interesting to see those shifts and dynamics and how we can bring the couple back to being a couple rather than, the patient and the caregiver. 

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Stefanie Taylor: Alexandria, there’s a great framework you shared around [00:14:00] sexual breaks and accelerators. Can you explain what those are and how they apply to someone after cancer? 

Alexandria: So the breaks and accelerators we actually got from Dr. Emily Nki, who has the book Come As You Are, and it’s a great book for relearning, especially for the female about your body.

Alexandria: I always say share it with the male partners too, so they understand as well. But with that, that the breaks and accelerators are really anything you can touch, tasty, smell, hear, feel, think, or imagine. And so basically everything around you. There’s no right or wrong for what you experience, and these are really the things that you know, your breaks that put you.

Alexandria: Back, say like, all right, no, I’m not gonna be intimate. They literally halt you. And the accelerators are the things that drive you. Especially going through cancer treatment, a lot of the common breaks that we see are around body image. Increased stress, pain, [00:15:00] nausea, that caregiving role sleep deprivation, the medically induced things like menopause.

Alexandria: Where the accelerators are, that trust, the attraction to your partner, feeling cared for or loved just having a relaxing day. Our brain is our largest sex organ. So if we can get it into a relaxed state, then you’re able to be more present and that intimacy can come. And definitely too, having those conversations with your partner and communication, we always say talk with your partner about sex outside of the bedroom so that you can have those conversations, express those concerns, those fears, things like that, so that you can then have that intimacy.

Alexandria: When you’re in the bedroom. 

Stefanie Taylor: Great key points to make the whole entire situation more approachable, less intimidating. Communication can feel awkward when it comes to intimacy. What tips do you have for having those important conversations with a partner?

Stefanie Taylor: How do you begin the conversation?[00:16:00] 

Alexandria: It can be really challenging to talk about sex and pleasure and those physical changes, especially as you’re going through cancer treatments. To start those conversations, we live in the age of technology. So send a text message about Hey, I’m thinking about you, or, I’d like to have this conversation about this. So the other person can be, prepared or write a letter. One thing too I tell people to do is play a game. Bring an old board game out, and let the conversation just happen organically.

Alexandria: When you have that. Fun levity, like in the middle, you’re playing Connect Four or Candy Land or something. It lends its way to having those challenging conversations and it doesn’t feel as stressful versus, sitting across from each other, sitting next to each other on a couch, looking at each other awkwardly.

Alexandria: And then, finding ways to spice up the romance a little bit, especially when you have that low desire. How do you get into the mood?

Alexandria: That’s where, text messages can happen or planning a date night. We have a lot of patients that, they’re so overwhelmed with the doctor’s appointments and the [00:17:00] scans and the treatment, like that’s their full-time job, and then they have that disconnect from their partner. So it’s saying, all right.

Alexandria: Thursday nights, our date night, we don’t have cancer as a topic of conversation. The kids are off the table, work’s off the table, we’re just gonna talk about each other. We’re gonna get to know each other again. And even having fun planning those different dates. It doesn’t have to be anything elaborate.

Alexandria: I’ve. Told a lot of people have a picnic in the middle of your living room or, get like the popcorn out. Have a movie date, something, simple like that. Or going to a park, going for a walk. It doesn’t even have to be around food. It’s just making sure that you have that time to truly be present and connect with each other.

Stefanie Taylor: It’s so important for survivors to make themselves a priority, before we go, if there’s one thing you want listeners to remember, what would it be? 

Alexandria: I would say is to give yourself grace throughout this process. There’s so many changes that happen to your body, to your relationship with yourself, with others, and there’s grieving that happens with that too.

Alexandria: It’s [00:18:00] important to give yourself, your body, that space, to grieve that as well as you’re relearning who you are now and redefining yourself as a person.

Stefanie Taylor: It is so important to realize you don’t have to go through this situation alone. And to those tuning in, thank you for joining. If today’s conversation resonated with you, you’re not alone. Thank you.