The sexual consequences of chronic pediatric disease are only now beginning to be studied. Most clinicians do not yet have the conceptual tools to thoroughly assess the sexual life of young adult hemophiliacs. This paper presents five major landmarks of sexual development: gender identity, orientation, intention, function (desire, arousal, orgasm, emotional satisfaction) and the enabling relationship. Several hypotheses about the impact of hemophilia are described. First, the illness identity of the person with chronic disease threatens to supercede the masculine gender identity. Second, an unappreciated high prevalence of orientation and intention problems lurk behind the high frequency of heterosexual “shyness”. Suggestions to maximize the sexual developmental potential of young hemophiliacs are provided based on our current concepts of child development and sexual development in particu