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.
"In some ways it's a shame that people rush to intercourse and skip all the courtship steps of sex," she says. "You don't learn to build and experience sustained arousal and you miss the chance to explore all the things you can do with each other's bodies that are pleasurable."
Pleasure, of course, doesn't have to be erotic.
"The bottom line is to accept some of the limitations that your health creates and know that you can have a full, loving relationship any way," says Kuriansky. "You're a whole person, not just your body. And while your body can have limitations, that does not mean you're tainted."
Starting the conversation
We liked this relationship advice, from the American Cancer Society website and Amber Tresca on About.com, as it applies to those with cancer and inflammatory bowel disease, respectively. Though targeted to specific illnesses, it applies to anyone who needs to broach this delicate topic. For more information, both sites offer much more advice: Go to cancer.org (type "sexuality" in the search field) or ibdcrohns.about.com (click on "coping"). Here are just a few tips:
Tell a potential partner about your physical challenges when you feel he or she already likes you for who you are. In other words, this is not necessarily fodder before or on your first date. It's better to find out earlier in a relationship than later if the person can handle the challenges.
If possible, gauge how your date reacts to other people with medical conditions. It can reveal a lot.
Bring up the subject followed by an open-ended question that invites discussion. Start with what you like about the relationship, ease into your particular challenges, then ask if he or she thinks it could affect a future together.
Continue the discussion in more depth when the relationship starts to deepen, especially if you have life expectancy or fertility issues.
Be prepared for possible rejection, and consider how you would respond. If you are rejected, don't let it prevent you from pursuing another relationship. Rejection happens to everybody; do your best not to take it personally.
Work on all areas of your social life: close and casual friends, family, co-workers. You deserve a network of people who support and love you.