Managing Sexual Health with a Bleeding Disorder

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For pre-teens and teens peer relationships and figuring out where they fit in socially are very important. Questions and concerns about self-esteem, self-worth, and social acceptance are common. But what happens when you add a bleeding disorder to the mix? This section of Next Step will address the issues of dating, sex, and social interactions during the pre-teen and teen years. You will also find tips on how to talk about sex with your child.

This section of Sexual Health covers:

What Teens and Pre-Teens Are Thinking About

Talking to Your Teen or Pre-teen

Tips on Having “The Talk”

What Teens and Pre-teens Are Thinking About

School field trips and extracurricular activities offer many great benefits to children and teens. Field trips Pre-teens and teens are discovering who they are and where they fit in. This can be both exciting and hard. For children with blood or bleeding disorders, their disorder may add a few more concerns. Their blood or bleeding disorder may make them feel different from their peers. They may be worried about dating and if they need to tell others about their disorder. They may want to share more about their experiences and correct any misinformation or they may choose to not to talk about their blood or bleeding disorder. Becoming sexually mature may bring up concerns about sexual activity or masturbation causing a bleed. Teens who menstruate and have a bleeding disorder may develop fears around how to manage their heavy periods. Open communication and accurate information from parents, caregivers, and trusted adults can help pre-teens and teens make appropriate decisions and feel comfortable with their bodies.

If you want more information about common questions pre-teens and teens may have about sex and dating, check out this video.

Talking to Your Teen or Pre-teen

Young people need information and guidance from parents, caregivers, or trusted adults to help educate them. Having the right information helps pre-teens and teens to make healthy and appropriate decisions about their sexual health. Sex education via the internet, social media, or peers can be inaccurate, inappropriate, and confusing. While talking about sex can be uncomfortable for parents and caregivers as well as pre-teens and teens, it is important. Learning about sexuality is a normal part of development. Answering your child’s questions in an honest and age-appropriate way is the best strategy. There are resources help you talk to your kids about sex in age-appropriate ways. The American Academy of Pediatrics’ healthychildren.org has articles on talking to a preschooler, school aged child, and teen.

Pre-teens and teens are naturally curious about sex. It is important to guide that curiosity, so they get accurate information. While talking about the responsibilities that come with being sexually active also tell your pre-teen and teen that it is okay to be curious about sex. You can talk about the possible consequences of being sexually active, including pregnancy and sexually transmitted infections (STIs). When discussing sex with your pre-teen and teen talk about the positive expressions of sexual feelings and the importance of feeling ownership of their bodies.

Some of the topics you may consider discussing with your pre-teen or teen are:

puberty
menstruation
masturbation
body image
Gender and sexual orientation
acceptance from their peers
consent
healthy, respectful relationships
sexting
pornography
contraception
pregnancy
sexually transmitted infections (STIs)
talking with a health care provider about sexual issues
how their bleeding disorder can affect relationships and sex

If you want more information about relationships, please go to Relationships and Disclosure.

Tips on Having “The Talk”

Before you talk with your pre-teen or teen, explore your own feelings about sex, including any potential awkwardness, embarrassment, or shame. This can affect how you have these important conversations with your child. Children look to their parents, caregivers, or trusted adults to see how they view sex and sexual behavior. It is important to be aware of your own feelings and judgements around these subjects. It is also helpful to think about beliefs and values you hold around sex and what, if any, you would like to relay.

Learning about sex does not usually occur in a single conversation. It is an unfolding process, and pre-teens and teens learn what they need to know over a period of time. Questions can be answered as they arise so that a child’s natural curiosity is satisfied as they mature.

Tips for talking with your pre-teen or teen about sex:

Encourage your pre-teen/teen to talk to you and ask questions. Let them know they can always speak with the Hemophilia Treatment Center (HTC) team. Tell them that conversations with a health care provider or HTC team can be confidential.
Try to determine your pre-teen or teen’s level of knowledge so that you can use words they will understand.
Help your pre-teen or teen understand their bleeding disorder in relation to sexuality. Help them understand the effects puberty can have on their body.
Remain calm and noncritical when talking with your pre-teen or teen.
Avoid indirect or slang terms for sex and body parts.
Keep your sense of humor. Don’t be afraid to talk about your own discomfort.
Share your values and concerns.
Discuss the importance of responsibility for choices and decisions.
A conversation about sex may be planned, but also don’t hesitate to take advantage of teachable moments that arise during everyday life. This could be an ad on tv, a scene from movie, or a question they ask that sparks conversation.
Find age-appropriate books about sex and developmental changes through adolescence for your pre-teen or teen to read to help start the conversation.

Open, honest, and ongoing communications about sex, responsibility, and choice can help pre-teens and teens learn in a healthy and positive way.

When it comes to talking with your pre-teen or teen about sex, intimacy and relationships, their HTC can also be a great resource. The social worker or nurse may have additional information to you and your pre-teen or teen about sex.

If you want more information about puberty, please go to Puberty.

It's normal to have questions and curiosity about sex, but it's also important to get the right information. Your body is changing, and you may have questions about sexuality and intimacy. You might be wondering how your blood or bleeding disorder affects your sexual health. Below you will find answers to your questions about sexual health and living with a bleeding or blood disorder.

This section will cover:

Questions About Sex

What is Safer Sex?

Young Adults: Dating, Sex & Intimacy with a Bleeding Disorder

Questions About Sex

Sometimes I feel insecure about my body. What should I do?

It can feel hard at times to love your body. Your bleeding disorder can cause bruises, nosebleeds, and swollen joints. However, you are unique, and no one’s body is perfect. Body image can improve when you care for your body, appreciate what it’s capable of, and accept its limits. Below are some ways to improve your body image:

Care for your body by eating healthy food and doing activities you love.
Celebrate what your body can do and accept any limitations.
Surround yourself with people who build you up.
Think positive. Every day, tell yourself three things you love about your body.

Can I get a bleed from kissing or hickeys?

Kissing, biting, and nibbling can draw blood to the skin’s surface. This can create a bruise or begin to bleed. If your partner has a lip or tongue piercing, they can cause additional damage to your skin. If you accidentally get a bruise or a break in your skin, it can be painful and cause an infection. If you see long term bleeding, bruising, or swelling anywhere talk to your Hemophilia Treatment Center (HTC) or health care provider. If your partner has a lip or tongue piercing, you can also ask them to take it out to prevent any injuries.

Is it okay to masturbate?

Masturbation is completely normal. Making sure your nails are cut and using lubrication can lessen the chance of injuring your skin. Bleeding in the arm, wrist, penis, or testicles can happen. You can have a bit of blood in your ejaculate or urine after masturbation. Vaginal bleeding can also happen. However, if you still have vaginal bleeding after a few days talk to a health care provider. You should also talk to your Hemophilia Treatment Center (HTC) or health care provider if you have pain or swelling, or blood in your urine after masturbation.

Will having sex give me a bleed?

Becoming sexually intimate is a big decision for anyone. There are different ways to be sexually intimate. Some examples are 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. Sex can involve parts of the body that have a lot of blood vessels, like the mouth, genitals, and anus.

Take steps to be safe if you have a bleeding disorder. There could be risk for bleeds in muscles like the calf, hip, lower back, or joints like knees or elbows. Talk with your Hemophilia Treatment Center (HTC) or health care provider if you have a bleed.

How will my bleeding disorder affect my periods?

Your bleeding disorder can cause your period to be heavier and/or last longer. When you start your period, it can take several months or more for it to become regular. However, a period that lasts longer than seven days is a sign of heavy menstrual bleeding (HMB). If your period causes you to change your pad or tampon every hour, it is also a sign of HMB. If you have HMB, your Hemophilia Treatment Center (HTC) or health care provider can help you to manage your heavy periods.

If you want more information about heavy periods or what to expect during puberty, please go to Periods or Puberty.

I am nervous about asking my health care provider questions about sex.  How do I have a conversation?

It is normal to be nervous or feel a bit awkward talking about sex with anyone, including health care providers. They are used to having conversations about sex. They can answer your questions professionally and keep the discussion confidential. Your Hemophilia Treatment Center (HTC) team or health care provider can help you understand how your disorder may affect your sexual health. Below are some tips to get the conversation started:

Tell your health care provider at the beginning of the appointment that you have some questions for them. If you let them know right away, they can plan for it and help you start the conversation.
Write the questions on a piece of paper or type them on your phone.
If you’re having a hard time getting the words out, you can always have your health care provider read the questions.
Be honest about what you are going through, even if it makes you feel nervous or uncomfortable.
Take notes if your health care provider gives you important information or instructions

What is Safer Sex?

Safer sex can mean a lot of things. Safer sex means protecting against sexually transmitted infections (STIs) and unintended pregnancy. Safer sex also means making sure all partners agree to a sexual activity.

Sexually transmitted infections (STIs) are transmitted via blood or body fluids, like ejaculate. The best prevention against STIs are barrier methods like internal or external condoms. Preventing STIs is the responsibility of all partners. If you have a STI, let your partner know ahead of time. If you have been exposed to a STI or fear that you might have been infected talk to your health care provider immediately. They can provide testing and the appropriate treatment.

There are many different ways to prevent pregnancy. Some of these methods require a prescription. You can talk to your Hemophilia Treatment Center (HTC) team or other health care provider to learn more about these.

If you decide to participate in a sexual activity, it is important that you and your partner both consent to it. Consent means that you are communicating permission, but also accept your partner’s answers. It is important that you fully understand the activity you are consenting to and that you voice your boundaries. You never have to do anything you don’t feel comfortable doing. You can also always change your mind, even if you have already started the activity. Consent cannot be given by a person who is drunk, sleeping, or unconscious. 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.

Always remember My Body – My Space – My Consent!

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What Teens and Pre-teens Are Thinking About

Talking to Your Teen or Pre-teen

Tips on Having “The Talk”

Questions About Sex

What is Safer Sex?