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Sex and Bleeding Disorders

Sex and Bleeding Disorders

If you are or planning to be sexually active, you need to know how your bleeding disorder will affect your sexual health.

This section of Step Up will focus on sex concerns for persons with bleeding disorders. It covers:

Sex and Your Bleeding Disorder

It’s natural to be concerned that having a bleeding disorder could affect a person’s sex life. However, people with bleeding disorders can have happy, healthy sex lives.

We’ll address some of the most common questions people with bleeding disorders have about sexual activity, whether you are a man or a woman, and regardless of which gender you are sexually active with. Your bleeding disorder doesn’t care who you are intimate with! You can learn more from these videos on sex and intimacy with bleeding disorders and then see other Q&A about sex below.

Is it safe to have sex when you have a bleeding disorder?

Yes, for a healthy person it is safe to have sex when you have a bleeding disorder as long as you take necessary precautions.

There are different ways to have sex. Some examples include vaginal sex, oral sex, anal sex, fingering, hand jobs, dry humping or genital rubbing and masturbation. Remember that a bleed can happen anywhere the blood flows and sex can involve parts of the body that have a lot of blood vessels, including the mouth, genitals and anus.

It’s important you work with your partner to find what works best for you. Having pillows and blankets nearby if you need support for certain positions can help, too. The most important thing is to only do what you and your partner feel comfortable with and communicate to make sure it’s consensual (agreed upon by both people).

Remember that having sex can have serious consequences, such as an unplanned pregnancy or contracting a sexually transmitted infection (STI).  It is important to take precautions to be safe. Only barrier methods like male and female condoms can protect against STIs.

Read below to learn about different bleeds to look out for.

What Signs of a Bleed Should I Watch Out for After I’ve Had Sex?

Sex is like most other strenuous physical activities for someone with a bleeding disorder, and it can cause a bleed in any part of the body including muscles or joints. 

Some parts of the body are particularly vulnerable to bleeds during and after sex, and the signs and symptoms may not be visible immediately. Some more common ones include bruises or hematomas, muscle bleeds in the calf or forearm, or a joint bleed. Signs of bleeding can include pain, limitation of motion and swelling. 

Men should look out for any injury to the penis, which may be marked by external bleeding, swelling, pain, and discoloration of the urine. Penis bleeds can be serious, so if you have any of these signs and symptoms, call your hemophilia treatment center (HTC) as soon as possible.

Sex may increase the risk of internal bleeding in the deep pelvic muscles in men, which may be hard to recognize. After sex some may experience lower back, abdominal, pelvic, groin and/or upper thigh pain, or numbness and tingling in the affected thigh if they bleed into their deep pelvic muscles.  These bleeds are commonly called psoas muscle bleeds but they really involve more than just that muscle. Some symptoms of psoas bleeds include inability to straighten your leg while lying back, or not being able to stand up straight.

With bleeds into your deep pelvic muscle there is a risk of artery, vein, and/or nerve damage due to compression of these structures by the swollen muscle. The nerve damage could become permanent if not treated promptly. Deep pelvic muscle bleeds can be limb and/or life threatening and should be considered a medical emergency. Call your hemophilia treatment center (HTC) team or hematologist as soon as possible for help and treatment instructions.

For women, even those without a bleeding disorder, vaginal bleeding during and after sex is not uncommon. If you have continual vaginal bleeding that goes on past a couple of days or you need more than two pads a day, call your hemophilia treatment center (HTC) or hematologist as soon as possible. 

If you experience an injury during sexual activity, stop, follow your usual treatment plan and reach out to your HTC or hematologist with questions or concerns.

Will I Be Safe from Bleeds if I Avoid Having Penetrative Sex?

The risk is about the same. Any physical activity can potentially cause a bleed; see the section above for tips.

Can I Have Sex During My Period?

Yes, you can have sex during your period. What’s most important is that you and your partner are both comfortable with the idea. Penetrative sex can result in increased bleeding. Remember that it’s still possible to become pregnant while you are menstruating.

How Can I Make My Partner Comfortable with the Idea of Period Sex?

Many women with bleeding disorders have periods that last for multiple weeks, so avoiding sex during menstruation would greatly restrict your sex life. However, depending on your partner, it may take some conversations and compromise for everyone to be comfortable with the idea of sex during menstruation. Experiment with different positions, try having sex in the shower, and invest in some dark towels. Your partner and you should commit to having a sex life that is fulfilling and enjoyable for both of you.

Is it Okay if I Masturbate?

Masturbation is completely natural for both men and women. Making sure nails are cut and lube is used can decrease friction and your chance of cuts or abrasions. Bleeding in the forearm, wrist, and genitals is possible. You may also have a bit of blood in your ejaculate or urine after masturbation. Urine should be clear the next time you pee. If you have ongoing pain, swelling or blood in your urine, contact your healthcare provider.

I am nervous about asking my doctor questions about sex.  How do I have a conversation?

It is normal to be nervous or feel a bit awkward about bringing up the topic of sex with anyone, including your medical team. They are used to having conversations about sex, and will be able to answer your questions professionally and keep the discussion confidential. Your medical team is one of the best resources for information about the impact that your bleeding disorder may have on all aspects of your life. But sometimes bringing it up can be difficult.

At the beginning of your appointment, tell your doctor or nurse that you have some questions for them. If you let them know at the beginning of the appointment, it can make it easier to start the conversation. If you wait too long, it may be harder to ask the questions. It can be helpful to write the questions on a piece of paper or on your phone and bring it with you to the appointment. This serves two purposes – you won’t forget the questions and, if you’re having difficulty getting the words out, you can always have your doctor or nurse read the questions. The most important thing is that you get your questions answered! If you go to a hemophilia treatment center (HTC) and feel more comfortable talking with your social worker, they can always help you come up with a good way to bring the questions up with your doctor or nurse.

Am I More Likely to Contract a Sexually Transmitted Infection (STI) If I Have a Bleeding Disorder?

No, your risk of contracting an STI is not higher because you have a bleeding disorder. However, regardless of your bleeding disorder, it is important to practice safer sex to decrease your risk of contracting an STI.  Read below for more information on how to practice safer sex.


Safer Sex

Safer sex can mean a lot of things, including protecting against sexually transmitted infections (STIs) and/or unintended pregnancy, and making sure sex itself is consensual, meaning agreed upon by both people.  It is important that partners discuss safer sex before becoming sexually intimate.

Sexually transmitted infections (STIs) are transmitted via blood or body fluids, such as ejaculate. The best prevention against STIs are barrier methods (male or female condoms). Preventing STIs is the responsibility of both partners. If you are HIV positive, or have hepatitis B or C, or any other STI, let your partner know ahead of time.

Some partners may be concerned about unintended pregnancies. There are many ways to prevent pregnancy for both men and women. Speak with your healthcare provider about what options work for you.

Make sure sex is consensual, meaning agreed upon by all people. Consent is only true consent if it is given by someone with a clear mind and without pressure or manipulation from anyone. Consent should be given freely (without coersion) and should be specific – just because you consent to one sexual activity does not automatically mean you have consented to another. You and/or your partner have every right to change your minds and stop any activity at any point.  You never have to do anything you are not comfortable with. You should ask your partner before initiating a new sexual activity so you are clear about consent. Without consent, any sexual activity (from touching to rape) is sexual assault. Visit the US Department of Health and Human Services’ website for information on sexual assault, rape and consent.