Sex

Should I worry about foreplay?

Kissing and oral sex can seem like a less risky option than penetrative sex, in terms of unwanted pregnancies, but you do still need to be responsible and aware of the potential for problems.
• Anything that involves deliberately drawing blood to the surface of the skin e.g. from a ‘love-bite’, can cause more of a problem for you than for someone without haemophilia; breaking the skin means that you could bleed for a long time
• A penile injury, though unlikely, may cause external bleeding, discoloration of urine, swelling or pain. If you have any of these symptoms, talk to your Haemophilia Centre or A&E department at your local hospital (depending on the urgency)

Is it safe for me to have sex?

Yes, although like anyone else you need to be responsible. It’s also advisable to use a condom whenever you have vaginal, anal or oral sex, to protect you against sexually transmitted infections (STIs) and, of course, prevent unwanted pregnancies via vaginal sex.

Because you have haemophilia, you should be aware of the potential for experiencing an internal bleed in your psoas muscles, which are anchored on either side of the lower spine and extend through the pelvic area to the hips. These muscles allow the hips to move freely, and help maintain an upright posture. Psoas bleeds may not be immediately apparent after sex, but if you find it difficult to straighten your legs whilst lying down, or find it difficult to get out of bed without using your hands to support yourself, you should go to your Haemophilia Centre for treatment straight away.

Are some sexual positions better than others?

While the type of sexual position you adopt has little to do with an increased risk of bleeding, if you have limited movement in your joints, or suffer from joint pain, you will find that some positions are easier than others. Try a few positions and you’re sure to find one that’s comfortable for you.

• If you have restricted movement or pain in your knees, you can lie on your back with your partner above you. This allows them to support their own body weight and provide most of the movement
• It may also be easier for you to have intercourse while lying side-by-side

Please note, you should watch for signs of a bleed after sex, such as:

• Bruising on the surface of the skin
• Bleeding into muscles, like the calf, forearm or hip, which can lead to stiffness, tingling, swelling, pain and restriction of movement
• Bleeding into joints like the knees, elbows and ankles after twisting or putting weight on them, which can lead to stiffness, pain and restriction of motion
• If you notice blood in the semen after sex, don’t panic. This condition is called haemospermia, and can happen to people with haemophilia from time-to-time. If this happens to you, make sure you tell your haemophilia healthcare professionals, who will be able to advise you further

How can regular Clotting Factor treatment (i.e. prophylaxis) help?

Prophylaxis will keep the level of Clotting Factor in your blood topped up, to reduce the number of bleeds that you may experience. This will help protect you from joint bleeds, which might be beneficial for the sexual aspect of your life. Speak to your Haemophilia Centre about tailoring your treatment to suit your needs.

What about contraception?

There are many different types of contraception for males and females that protect against unwanted pregnancies. However, to protect against STIs as well, you’ll have to use a condom.

What are condoms exactly?

Though female condoms are available, we’ll focus on male condoms here. They’re worn on the penis to stop sperm from entering your partner's vagina, mouth or anus, and are made of very thin latex. (They’re also available in polyurethane or polyisoprene for people who have a latex allergy.) Condoms come in many different sizes, shapes, colours, textures and flavours, so you can experiment and find the ones that suit you. You can even use stronger condoms (with thicker latex) for anal intercourse, as this normally places more strain on the condom. Standard condoms, however, are just as effective as long as they are used correctly with plenty of lubricant.

You can find out more about the different types of condoms available here: avert.org/condom.htm

How do I use condoms?

It’s important to use condoms properly as, if handled the wrong way, they can slip off or split. If you’re using condoms for the first time, it’s a good idea to practise putting them on properly before attempting to use them for sex. Also, make sure you put a condom on your penis when it’s erect, before it comes into contact with the vagina, mouth or anus. Below are a few steps to help you wear condoms correctly:

• Remove the condom from its packet
• Place the condom over the tip of the erect penis
• Use your thumb and forefinger to squeeze the air out of the teat (on the end of the condom)
• Gently roll the condom down to the base of the penis (If the condom won't roll down, you're probably holding it the wrong way round. If this happens, throw the condom away, as it may have semen on it, and try again with a new one)
• After sex withdraw the erect penis, being careful to hold the condom on to the base of the penis
• Remove the condom from the penis, being careful not to spill any semen. Dispose of the condom in a bin, don’t throw it down the toilet

How effective are condoms?

If used correctly and consistently, condoms are 98% effective; there’s a two percent chance of you making your partner, if female, pregnant.
• If the condom splits or comes off, you should contact a pharmacist or doctor for emergency contraception
• Also, if you have been at risk of pregnancy, you’ve been at risk of STIs, so it’s a good idea to have an STI-check at a GP surgery, contraceptive clinic, sexual health clinic, genitourinary medicine (GUM) clinic or young person's clinic

For more information on STIs visit: nhs.uk/Livewell/STIs/Pages/STIs-hub.aspx

Where can I get condoms?

You can buy condoms from most places: chemists, corner shops and supermarkets. Just make sure you buy brands that have ‘CE’ on the packet, as this means they've been tested to European safety standards.

Asides buying condoms, you can also collect them for free from: community contraceptive clinics, sexual health and GUM clinics, as well as some GP surgeries.

If you’d like any more information about contraception, talk to the healthcare professionals at your Haemophilia Centre, or find your nearest contraceptive service from the NHS. These can sometimes be found in GP centres, and offer free and confidential advice.