Hemophilia and Sexual Diversity? “Straight Talk” for the gay hemophiliac

You’re Not Alone. Here’s What You Need to Know.

Whether you're gay or straight, if you have hemophilia you're a part of our community. Ed Kuebler, social worker at the University of Texas Gulf States Hemophilia and Thrombophilia Center and director of Step Up Reach Out program for young leaders of international hemophilia communities, answers some of the biggest questions that young gay men with hemophilia often ask.

Is gay sex more risky than straight sex if you have hemophilia?

No. Like any strenuous physical activity for someone with hemophilia, sex is risky to the extent that it can increase the possibility of a bleed. This holds true for both gay and straight sex.

You can experience a bleed anywhere that blood flows. Most sexual acts—whether gay or straight—involve highly vascular parts of the body (meaning that they have lots of blood vessels) like the mouth, genitals and anus. You should be particularly aware of the potential for a bleed in these areas and watch for signs of problems after you have sex.

What signs of a bleed should I watch out for after I’ve had sex?

Sexual activity could cause bleeding anywhere in the body, including your joints. However, some parts of the body are particularly vulnerable to bleeds during and after sex, and the symptoms might not be immediately obvious to the untrained eye.

Things you should look out for include an injury to the penis, which could be marked by external bleeding, a change in the color of your urine, swelling or pain. If you have any of these symptoms you should seek professional medical help as soon as possible.

Sex also increases the risk of an internal bleed in your psoas muscles (little-known but important muscles that extend from either side of your spine through your pelvis and continue on to your hip joints). Psoas bleeds can be extremely hard to recognize. If you have sex and find afterwards that you can’t straighten your legs while lying down, or if you need to use your hands to support yourself when you stand up, you should contact your treatment center or hematologist as soon as possible. This may require going to the emergency room.

Is it safe for me to have sex if I’m gay and have hemophilia?

Physically, depending on the severity of your hemophilia and how careful you are, it should be safe for you to have sex.

Of course, if you’re thinking about having sex with your partner, you have to consider much more than your physical wellbeing. You also have to take into account your circumstances, beliefs and values. These are really important issues you should think long and hard about; they’re also issues that can, of course, be incredibly complicated and difficult for someone who’s gay. But with the right person, at the right time, and with the right precautions, sex can be a wonderful thing.

It’s also essential that you use protection (a condom) whenever you have sex—including anal and oral sex. Condoms are a vital way of protecting you from contracting viruses including HIV, hepatitis B or C or other sexually transmitted diseases (STDs).

Does being gay place extra stress on someone who has hemophilia?

For any guy with hemophilia, the transition from adolescence to adulthood can be difficult. Add to that the lack of education around same sex relationships, people’s lack of tolerance for being different, cultural and religious beliefs that condemn people who are gay provide an array of (deeply unfair) pressures gay men all over the world still have to cope with—dealing with ignorance and discrimination, for example, or hiding their sexuality from their friends and family—and you have a potent recipe for stress.

If you are gay, the first thing you have realize is that you have absolutely nothing to be ashamed of. Second, you have to know that you’re not alone, even if it seems like no one you know is gay or would understand what you’re going through.

Finally, talk to someone you trust about how you feel. This could be a professional counselor or therapist, a close friend, or a member of your healthcare team. If you don’t have anyone you feel comfortable turning to in person, you might want to go online and learn from the experiences of other people.

Will I be safe from bleeds if I don’t have penetrative sex with my partner?

Sexual activities like kissing and oral sex can seem less risky than penetrative sex, but still carry an increased risk of bleeding. Anything that brings blood to the surface of the skin, from biting and nibbling to getting a hickie, can cause problems for someone with hemophilia.

Does being gay and having hemophilia make me more likely to contract a sexually transmitted disease?

It doesn’t matter if you’re gay or straight: if you have unsafe sex (sex without a condom)—and don’t use the condom properly—you’re at risk of getting an STD. Even if you think you know your partner’s sexual history, you can’t be sure about it. Also remember that condoms aren’t 100 percent reliable, so the more you have sex, and the more sexual partners you have, the greater your exposure. Ultimately, it’s down to you to be responsible and manage your risk.