Sexuality and haemophilia: connections across the life-span.

A broad overview of sexuality issues and needs as they relate to haemophilia are presented. Venturing well beyond 'safer sex', sexuality is defined here to encompass physical, emotional, social, interpersonal, moral, and cultural aspects. From this perspective, sexuality extends beyond behaviour and includes a person's thoughts, feelings, nature, and identity. As a means of experiencing intimacy, sexuality is a significant factor in achieving quality of life with chronic illness. Its impact in haemophilia is influenced by different stages of physical and psychosexual development, misconceptions about sexuality, and unique concerns for this group, including joint disability, human immunodeficiency virus, medication side-effects, and other complications. This paper explores the interconnections of sexuality with haemophilia, with a focus on the roles that haemophilia care providers can play in addressing these issues. A biopsychosocial model of aspects and interrelationships regarding sexuality and haemophilia is proposed for use in understanding individuals and planning care approaches. The PLISSIT model is offered to guide counselling about sexuality on different levels of complexity. Sample strategies for initiating discussion, communicating about sex, and developing goals and interventions are presented.