Confusion abounds during both phases. But if you're living in the second phase — that is, you're an adult — confusion is compounded by frustration and even heartbreak when your body won't cooperate.
Add in other types of cancer, spinal cord injuries, endocrine disorders, diabetic neuropathy, certain birth defects and hormonal deficiencies — all of which contribute to sexual dysfunction and in extreme cases preclude sexual intercourse altogether — and it's clear a large, if unmeasured, portion of the population is struggling to balance the desire for intimacy with the reality of health complications.
"What we see in our culture is that you can't have a relationship without intercourse and that's so not the truth," says Patty Brisben, co-author of "Sexy Ever After: Intimacy Post-Cancer" (Good in Bed Guides). "Life doesn't end because you can't have intercourse."
Brisben is the founder of Pure Romance, a company that sells relationship-enhancing products through in-home parties. She says women and men frequently approach her at sales events to confide anxiety over sexual dysfunction.
"Baby boomers especially are opening the door and saying, 'Nobody told me about these changes. Nobody told me it would be this painful,'" she says. "We need to support people and let them know they're not moving through this alone."
But the situation can feel lonely, especially if you're struggling with how to broach the topic with a partner or potential partner. Handled with care, however, it can actually benefit a relationship, say experts.
"If they handle it with respect and you feel like you're not going to be hurt by their reaction, it tells you where your relationship is going," says Judith Kuriansky, a psychologist on the faculty of Columbia University Teachers College and author of "The Complete Idiot's Guide to Dating" (Alpha).
"If you can't get through this together, the relationship is doomed anyway," Kuriansky says. "If you know upfront the person can't accept this about you and all the implications, there's no point."
Don't jump to conclusions
But take care, she says, not to base any decision on a single conversation.
"Don't have the conversation once and think it's done," she says. "As simple or complicated as the health issues are, you'll need to have many discussions about how important sex is to the other person, how it affects a relationship, even how you both feel about having these kinds of conversations."
And remember that you're not necessarily delivering devastating news.
"Sometimes, especially when you first start dating, it's a relief to the other person," says Carol Ellison, a clinical psychologist based in Oakland, Calif., specializing in sexuality and intimacy. "Men, especially, have performance anxiety and it can relieve some pressure to know they don't need to worry about the ability to get and sustain an erection."
And intimacy is still very possible.
"I define successful sex as creating mutual erotic pleasure in whatever form it takes so you end up feeling good about yourself, good about your partner, and it enhances your relationship," says Ellison. "Usually my first intervention in sex therapy is to say, 'Quit trying to have intercourse.' It opens up a huge array of possibilities and lets you focus on enjoying yourself and not 'Am I doing what I'm supposed to be doing?' "
There was a time, Ellison recalls, when couples played the "everything but …" game. Not such a bad thing.