How can the use of session_start() impact the functionality of accessing session variables in PHP, and what are the implications of not including it in the code?

When using session variables in PHP, it is essential to include session_start() at the beginning of the script to start a session. Without session_start(), accessing session variables will not work correctly as the session needs to be initialized. Therefore, failing to include session_start() will result in errors or the inability to access session variables.

<?php
session_start();

// Accessing session variables
$_SESSION['username'] = 'JohnDoe';
echo $_SESSION['username'];
?>