People with haemophilia have to be more careful than others when having sex.

They could suffer severe bleeding as sexual intercourse strains muscles in the pelvic area, where bleeding is most common, said Associate Professor Tien Sim Leng, director of the Haemophilia Centre at Singapore General Hospital.

The muscles are used when the pelvis makes thrusting motions during sexual activity, and internal bleeding from these muscles could be fatal if left untreated, Prof Tien noted.

Therefore, patients should be more open about sexual health, and initiate discussions with their doctors or nurses regarding any sexual questions or concerns they might have, said the senior consultant in the department of haematology.

More comfortable sexual positions should be explored if the person has certain joint deformities or contractures.

External bleeding from, say, love bites is visible, and can be treated easily with clotting factors if it is severe or persistent, said Prof Tien.

Sexual counselling will be provided by doctors or nurses if the issue is raised by patients.

Physiotherapists can assess the joints, and offer therapy to strengthen the muscles around them. Strong muscles protect the joints, which could help reduce bleeding during physical exertion, said Prof Tien.

Prophylaxis treatment with clotting factors might also help.

If the sexual activity is likely to be vigorous, for example, a patient could top up on clotting factors before engaging in it, Prof Tien suggested.

Ng Wan Ching