Low Libido After Ovarian Cancer: Is It Common and How Can It Be Managed?

Low libido (reduced sexual desire) is a common and understandable effect after ovarian cancer treatment, often linked to abrupt menopause, vaginal dryness, pain with sex, fatigue, and emotional stress. ^[1] Many women treated for gynecologic cancers report decreased desire, changes in arousal, and discomfort during intercourse. Improving vaginal comfort often improves desire and arousal, so addressing dryness and pain is a key first step. ^[1]

Why It Happens

• Abrupt menopause (treatment-induced): Surgery to remove ovaries or chemotherapy can lead to sudden loss of ovarian hormones, causing intense vaginal dryness, narrowing, and pain with intercourse, which can reduce desire. ^{[2] [3]}
• Vaginal tissue changes: Pelvic treatments may lead to vulvovaginal atrophy (thinning and dryness of vaginal tissues), increasing discomfort and lowering sexual interest. ^[4]
• Pain and fatigue: Persistent fatigue and pain make intimacy difficult and can further lower libido. ^[5]
• Emotional impacts: Body image changes, anxiety, and low mood after cancer can suppress sexual interest. These emotional factors are common and valid and can be addressed with supportive care. ^[6]

How Common Is Low Libido?

Surveys of women after breast and gynecologic cancers show large unmet sexual health needs, with more than half reporting concerns about sexual function; in one assessment, about 51% reported loss of libido alongside high rates of vaginal dryness and pain. ^{[7] [8]} Women with ovarian cancer specifically often report changes in sexual desire and pleasure due to therapy effects and menopausal symptoms. ^{[9] [5]}

First-Line Management: Nonhormonal Strategies

• Vaginal moisturizers and lubricants: Regular use of moisturizers (several times weekly) plus lubricants during sex can reduce dryness and pain, which may restore desire and arousal as comfort improves. ^{[3] [7]}
• Pelvic floor therapy: Specialized physical therapy can help pelvic pain, tightness, or narrowing, improving comfort and confidence with intimacy. ^[2]
• Vaginal dilators and gentle stretching: These can gradually improve elasticity and reduce discomfort with penetration for women who experience narrowing. ^[2]
• Sex therapy and counseling: Working with clinicians experienced in female sexual medicine can address pain, fatigue, relationship dynamics, and anxiety, which can meaningfully improve libido. ^{[5] [10]}
• Education and proactive discussion: Many women prefer when clinicians initiate the conversation; structured interventions after cancer can significantly improve sexual function and quality of life. ^{[11] [12]}

Considering Hormonal Options

• Local vaginal estrogen (low-dose): For persistent vulvovaginal atrophy, local estrogen (cream, tablet, ring) can improve dryness and pain, and by improving comfort may help desire; suitability depends on cancer type, treatment history, and oncologist guidance. ^[4]
• Systemic hormone therapy: In carefully selected cases (and when oncologically appropriate), systemic hormone therapy may be discussed to relieve abrupt menopausal symptoms; this requires individualized risk–benefit evaluation with the oncology and menopause care team. ^[4]
• Nonhormonal alternatives for vasomotor symptoms: If hormones aren’t appropriate, nonhormonal treatments for hot flashes and sleep can improve overall wellbeing and indirectly support sexual health. ^[10]

Addressing Pain, Dryness, and Arousal Together

Because desire often returns when sex becomes comfortable, focus on stepwise relief of pain and dryness along with arousal strategies: start with moisturizers and lubricants, consider pelvic therapy or dilators, and add local estrogen if appropriate. ^{[3] [4]} Smooth communication with partners, extended foreplay, and gradual reintroduction of intimacy can reduce anxiety and improve arousal. ^[10]

When to Seek Specialized Care

If low libido persists or sex remains painful despite self-care, consider referral to a Female Sexual Medicine program for multidisciplinary support, including medical treatment, pelvic therapy, and counseling tailored to gynecologic cancer survivors. ^[5] Such programs can also coordinate with other specialists to treat underlying issues contributing to sexual difficulties. ^[13]

Practical Tips You Can Try Now

• Use a high-quality water- or silicone-based lubricant during every sexual activity to reduce friction and pain. ^[3]
• Apply a vaginal moisturizer 2–4 times per week to improve baseline hydration. ^[7]
• Practice gentle pelvic floor relaxation and breathing; consider a pelvic health therapist if pain or tightness persists. ^[2]
• Schedule intimacy when fatigue is lowest, and prioritize nonpenetrative touch to rebuild comfort and desire. ^[10]
• Discuss options like local estrogen with your oncology team if dryness and pain remain significant. ^[4]
• Seek specialty sexual health support, which is available and designed for cancer survivors. ^{[5] [11]}

Key Takeaway

Low libido after ovarian cancer treatment is common and multifactorial, often tied to abrupt menopause, vaginal dryness, pain, fatigue, and emotional stress. The good news is that targeted treatments especially relieving vaginal dryness and pain often improve desire and arousal, and specialized sexual health programs can provide comprehensive, evidence-based support. ^{[1] [4] [5] [11]}