Hello Katie.
Yes, I am an OB - GYN Specialist and would be glad to assist you with your concern.
Let us take it one by one.
1. Generally hemophilia does not affect sexual activity. Most females with hemophilia would not bleed during sex. Only with vigorous sexual activity, there might be bleeds deep within the hip muscles.
2. Of course, a legally mandated report of abuse is a must from the doctor's side. Specially as the girl is pre pubertal, hemophiliac and underaged.
3. A hemophiliac female might sustain injuries to the external genitals from attempted rape. These injuries might bleed for a variable period of time. Again, she might not bleed, the presentation is myriad and varied.
Also, is it possible that she is confusing molestation with penile penetration and proper rape ?
It is also possible that she maybe scared and hence might have lain stiff and co operated with the rape, thus limiting the nature and intensity of possible injuries to the external and internal genitalia.
If she had bled, and it was not attended to immediately, then she would have been exsanguinated, and would have definitely required transfusion with blood / clotting factors .
4. It is not impossible to have full penile sex with a prepubertal 9 year old. Vaginal atresia is now a different issue.
Vaginal atresia is of varying degrees, with partial atresia, some amount of penile penetration is still possible.
She would be unestrogenized, but of course, forcible penetration can be achieved.
I need to know the degree of vaginal atresia that she has, and how truthful / perceptive she is likely to be when she is making that claim.
5. Regarding anal sex, if it was forced, there would surely be signs of rectal tear, anal tear. Scarring is doubtful, as the injuries in a young girl might heal well.
But there would most definitely be evidence of acute injuries / tears in the area.
It is possible to have had anal sex without long term inner rectal scarring.
Hope this has been of some help.
Let me know on what points you want me to elaborate further.
Regards.