Sex and emetophobia

It wasn’t until a client once asked me if it were ok to talk about sex that I started to think about sex and emetophobia. I reassured them that they can talk to me about absolutely anything. One might think that we 60-something grandmas don’t know much about the subject except for the missionary position in a long flannel nightie, but let me revamp our image for you: we went to college in the 70s. THE SEVENTIES. All the girls were on birth control pills, and there wasn’t any disease you could catch from a partner except gonorrhoea, which if you were so unfortunate, could be cleared up with one dose of penicillin. The good old days before herpes and HIV. Imagine it.

My first counselling gig was at the University of Waterloo “Peer Counselling Centre” in 1976. With some good, solid training, we volunteered a few hours a week talking to our peers about sex, birth control, abortion, being gay, being born in the wrong gender. Yes, 44 YEARS later we’re still talking about that.

But I digress. Emetophobics actually have a few things to worry about when it comes to sex, especially with some of the latest activities that many couples enjoy. What’s worse is that they’re often afraid to share these fears with their sexual partner.

I’ll try to be crystal clear, so you may want to read this blog in private.

Oral sex

Oral sex can present a problem to either male or female emetophobes. For the (straight) female or gay male the possibility of gagging on either the penis or the ejaculate can be terrifying. Men can become equally terrified of their partner gagging and even vomiting during oral sex. There are some emetophobic queer women who are quite reluctant to perform oral sex on another woman.

anal sex

Considering that Norovirus particles are contained in fecal matter, anal sex can be daunting whether one is the giver or the receiver. The problem is that the penis (or sex toy) is removed, theoretically contaminated. And then what do you/they do with it? We all know it’s not getting near your mouth anytime this century. But does he know that?

anilingus

Yep. I had to look that one up. Thanks to a comedy routine by Chris Rock, I heard it was called “tossing his salad.” Apparently there are a plethora of other terms. Suffice it to say that your average emetophobic would not be caught dead doing this one, which involves your tongue and your partner’s anus.

anal-digital stimulation

What’s he going to do with that hand now?

the solution

This may seem ridiculously simple, but you have to talk to your partner about the kind of things you like to do, and what you feel uncomfortable with. If you’re afraid to do just about everything, and your partner really wants to be adventurous then perhaps they aren’t the right partner for you. But if you’re already married to them, then there needs to be some give and take. Explain what frightens you. It’s easy enough for him not to push his penis too far into your mouth, and to let you know when he’s about to ejaculate. If they want anal sex, you might have to negotiate a shower afterward before doing anything else. You get the idea. Talk. If you can’t talk to someone with whom you’ve taken off all your clothes, then who can you talk to?

The other, perhaps more obvious solution, is to get treatment for your emetophobia. It really is treatable, and you don’t need to be afraid of the many things in life that non-emetophobics enjoy forever.

Best of luck, and remember that you can discuss anything with your therapist if need be.

The Dreaded Colonoscopy

Often I work with clients who have gastro-intestinal issues. Their doctors almost always recommend a colonoscopy. It’s a simple procedure done under heavy sedation (you’re usually totally asleep, but not under general anesthetic). Most emetophobics aren’t too worried about the procedure; they’re just terribly worried about the prep the day before. Since it’s important that your whole colon is clean as a whistle, you’re usually told to eat no fibre for a day or two, then have only clear fluids the next day, and then drink some form of powerful laxative to clean out your colon. Yes, it’s a day of diarrhea, but it beats paying for one of those “colon cleanses” at a spa, since it’s the same thing and generally paid for by your insurance or medical system. And of course it’s waaaaaay better than getting colon cancer! I myself have had several of these procedures and I don’t mind them at all anymore. Then again I don’t have emetophobia anymore so maybe that doesn’t count.

So why is it “dreaded?” Well, emetophobics worry that drinking the laxative will make them sick. Even though I’ve never talked to a single emetophobic who ever got sick from it. Some folks who have very weak stomachs and are NOT afraid of vomiting report getting sick from it. These people are not you guys! Emetophobics can control vomiting at the worst of times, and this is not the worst of times.

One of my clients, Jessica, has gone through several colonoscopies when she was very phobic, and she was kind enough to write a short post about it. So here it is:

“Three years ago I had whittled down to 100 pounds after being nauseous and having an upset stomach for seven months (an emetophobic’s worst nightmare). I finally got an appointment with a GI doctor who suspected Crohn’s Disease from my symptoms. When he mentioned the colonoscopy procedure to confirm, my chest tightened and heart stopped. How was I ever going to drink all the liquid to prep for it? What if it made me sick? I had only ever heard how terrible prepping for one was.

I made a decision. I immediately went into fight mode, toughened up, and decided to just do it. I surprised myself when it was way easier than I imagined. I was instructed to drink 64 ounces (2 litres) of Gatorade mixed with the prep medicine. To make it easier, I drank the prep/Gatorade mix with a straw over ice. I stayed calm, stayed distracted, and reminded myself it was a temporary discomfort for a healthier me. I watched a tv show and played Yahtzee with my family.

The next morning I went to the hospital, and completed the colonoscopy under general anesthetic. I woke up next to my husband and nurse. My doctor made sure I stayed comfortable in the recovery room as well. They offered me anti nausea medicine for when I was coming out of the anesthesia and warm blankets for my feet. Once I was home, it was like nothing had ever happened. I’ve had two colonoscopies in the last three years and when it comes time for my next one, I will be excited for the best nap I’ve ever had.

Nothing is as ever bad as our heads tell us it is.”

Anna’s notes: 1) Most colonoscopies are not performed under general anesthetic anymore, but rather “conscious sedation.” There’s no nausea afterward. 2) The prep mixtures are getting way better with every passing year. For my last one, I only had to drink a small bottle (less than a cup) of lemon-flavoured liquid the night before and another one the morning of. 3) Jessica met with me for about 14 sessions and is doing great! Thank you, Jessica, for submitting this for me!

coronavirus and emetophobia

Edit: August 7, 2020. Wear a mask over your nose and mouth. Don’t touch it except to put it on and take it off. If you have to go out, try to keep 2 metres away from other people, even if they’re wearing masks. Don’t congregate in groups larger than 10, and be sure to know everyone in the group or have some contact info for them. Get tested if you show any symptoms at all.

Edit: March 12, 2020. “Cancel Everything” – don’t go out unnecessarily to places where there are a lot of people. Avoid travel. Protect the elderly. End edit.

When Coronavirus was first publicized in January, many of the Facebook pages and chat sites for emetophobia carried the same message: “I’m not afraid of it, because none of the symptoms is vomiting.” In other words, if you’re only afraid of vomiting and not of dying then you’re good. If truth be known, emetophobic people are also afraid of dying – they just don’t realize it. Vomiting=dying in some part of the emetophobic brain. Other forms of dying we feel pretty much immune to, even though there is risk involved. Phobics are naturally unwilling to take any amount of risk as it relates to the thing they fear, even though they’re quite willing to get into an automobile every day.

I was hoping that the conversation might be a bit more realistic, which it has now become: we germ phobics have something to teach the rest of the world – good hygiene! Wash your hands well, and don’t touch your face, meaning the “T-zone” of eyes, nose, mouth. Those are the mucus membranes just waiting for the virus to find its entry point.

With norovirus, touching one’s nose is less likely to infect you, and touching the eyes even less, as norovirus must be “swallowed,” meaning vomit or fecal matter has to make its way to your stomach and intestines. Ew. Coronavirus, on the other hand, just needs to make its way, via your mucus membranes, to your lungs. Gah!

Wearing a mask may help you to remember not to touch your mouth or nose, but as masks are in high demand just now it’s better to leave those for folks who are actually sick. That way, their sneezes and coughs can’t infect anyone else. Gloves are pretty useless because, just like hands, they touch everything and are quickly covered in germs.

Click here to link to a great Washington Post article that talks about the psychology of why refraining to touch our faces is so difficult.

Six Degrees of Separation

There’s a running joke in Hollywood that there are only ever six degrees of separation from any actor to Kevin Bacon. If you’re a real movie buff you can play the game with your friends and try to figure it out.

The Kevin Bacon game works pretty much with any actor, as it’s based on the idea that there are only six degrees of separation from any one person to another on the planet. It got me to thinking…

I find that a lot of my emetophobia clients who have a fear of vomiting worry extensively (some much more than others) about the degrees of separation of Norovirus (aka “stomach flu” or “stomach bug”)[1]. What I mean by this is they’re afraid that someone with Norovirus touched this, then that, then what if I touch this, then, that – is “that” contaminated with Norovirus? Here’s an example of what I mean:

  1. Bob has Norovirus
  2. Bob doesn’t wash his hands after using the bathroom. There are Norovirus particles on his hands
  3. Bob opens the door
  4. Bob picks up his keys
  5. Bob opens his car door
  6. Bob drives to the grocery store
  7. Bob gets a grocery cart
  8. Bob grabs a box of granola bars, reads the label, then puts it back.
  9. A few moments later I grab the granola bars and put them in my cart. I buy them and they get put in a bag
  10. I touch the bag handles
  11. I touch my purse handles and keys
  12. I eat a burger without washing my hands
  13. I will get Norovirus.

I now believe that I must wash my hands, my purse handles, and wipe everything item of my groceries or I will catch Norovirus.

Here’s the thing: you won’t. Norovirus is very contagious, true, but what we have here are TWELVE degrees of separation from the Norovirus particles and you. That’s way too many for the virus to still be active. Here’s what can happen at the grocery store:

  1. A kid has Norovirus
  2. The kid doesn’t wash his hands after using the bathroom.
  3. He touches nothing until the grocery cart handle.
  4. You use the cart next and touch the handle.
  5. You put your fingers in your mouth or eat a burger.
  6. You get Norovirus

That’s six, right? So yes – you could get Norovirus this way. But NOT IF THERE ARE ANY MORE THAN SIX. Because I’m actually talking about one item touched by the kid, touched by you (the grocery cart), and I’m also talking about invisible Norovirus particles, not visible poo. Ew. Sorry for that. This is why there are wipes in grocery stores now, for your cart handles.

Here are the items you don’t want to touch, then put your hand in your mouth:

  1. Anything in someone else’s bathroom, or yours if someone in your house has Norovirus: toilet flusher, taps, soap dispenser, paper towel dispenser, countertops, cups, toothbrushes, toiletries or makeup, door handles.
  2. Doorknobs
  3. Other people’s phones (your phone is fine)
  4. Light switches (especially in bathrooms)
  5. Elevator buttons
  6. Gas pumps
  7. Other people’s hands

 For all you emetophobia folks out there, let’s review how you might catch Norovirus:

  1. Someone with Norovirus throws up within ten feet of you. That’s about the radius that the aerosolized particles can travel, although it’s more like seven feet to the side. (Now you know why it’s so contagious in schools.)
  2. Diarrhea in a toilet can become aerosolized when the toilet is flushed. It can land on toothbrushes across a room.
  3. Someone in the food production business doesn’t wash hands and touches your salad or hamburger bun.
  4. You touch something from the list, above, don’t wash your hands, then put your hands in your mouth. You could theoretically catch it from putting your finger in your nose, but it’s highly unlikely, and even more unlikely you’d catch it from touching your eye. Zero chance from touching your face.

There is more information on the Norovirus page of my website including myths about how it is caught. The truth is, most Norovirus is spread by children. They suck at handwashing. Apparently so do caregivers in nursing homes.

The good news is that it’s really easy to get the virus off your hands – you just wash them with plain soap and water. Emetophobia folks will tell you about all the things that kill Norovirus, but if you wash your hands before putting them in your mouth you really don’t need to worry.


[1] Noroviruses are neither a “flu” nor a “bug” – those are just sayings.

Being Thankful

As an emetophobic, it can be hard to truly appreciate the holidays. You often have to travel by car or plane, stay at someone else’s house, eat food cooked by someone else, and put up with all the family members including little ones who can be germy to say the least.

Our Canadian Thanksgiving has passed now, but I am aware that most of my clients are from the USA, and their Thanksgiving is looming. Not being thankful, in fact not enjoying oneself, can bring with it guilt and shame. Everyone else is having a good time sharing food and wine, stories and games. You might be curled up in a chair away from people staring at your phone, not wanting to eat. “Waiting.”

Many ask me if I have any “tips” for getting through the holidays. I do not. Recovering from a serious anxiety disorder such as emetophobia is not about tips or five steps to a cure, or a quick fix. It is a slow, methodical process; a road that is straight uphill. Let me share this with you, however: you can do it. You can get through the holidays; you can cope with whatever happens. You know darn well you’re going to wash your hands and not put them or anything you’ve touched in your mouth anyway. So the chances of YOU getting sick are pretty much non-existent. If other people are sick that would be upsetting, but nothing bad will happen to you. You may be afraid, but you’ll be ok. Try to remember this – write it on a little card, perhaps, and take it with you for the weekend. Refer to it whenever you feel your anxiety start to rise.

What about being thankful? Everyone else will talk about being thankful for food (probably not you) and for family (even those germy kids?) and for other various aspects of privilege. You may feel that while you’re suffering so much, you don’t feel very thankful for your life at all. When I was a kid, I made the same wish blowing out the candles on every birthday cake: I wish I didn’t have this phobia! I figured the wishing didn’t work. But here I am at 61, nearly twenty years completely free of it. So maybe it worked after all. It just wasn’t instant.

Here are a few thanksgivings to ponder:

  1. I am thankful that I live in America (or any other country that celebrates Thanksgiving). There is treatment for emetophobia here.
  2. I am thankful that I live in the information age, so I can find out lots about emetophobia right at my fingertips.
  3. I am thankful that I live in the age of Social Media, so I don’t feel alone with this and it’s pretty easy to have someone to “talk to.”
  4. I am thankful that people are studying emetophobia and conducting research all the time, so it may be easier to get treatment very soon.
  5. I am thankful that people are working diligently on developing a Norovirus vaccine!

What Causes Emetophobia?

This post has been moved from my previous website.

Like any other phobia or anxiety disorder, the exact cause is unknown. Why do some people develop a phobia of dogs after being bitten by a dog as a child, but others do not? Some folks remember a traumatic incident involving vomiting when they were young. Perhaps they were vomited on, or they vomited in school and were embarassed. Yet this happens to many children and not all develop phobias. So although scholars do not know the exact cause, there are many things they do know.

  1. Phobics have a genetic predisposition to anxiety. Probably your mother, father, or one of your grandparents was an anxious person. It may be an aunt or uncle. Whoever it is, it’s in your family. That person may have been able to hide it, but it will be there. Genetics (nature) only accounts for about half of the cause, however. The other half is experience (nurture).
  2. Most emetophobics that I have spoken with online (thousands) or worked with as my own clients (over one hundred) had something happen to them in childhood that disrupted the normal resolving of attachment with their mothers. When I say “resolving” I mean that as babies we have a very close attachment to our moms, however with the passage of time this naturally resolves and we begin to trust the world, other people, and can manage on our own (“independence”/”interdependence”). The disruption of the attachment resolve does not need to be dramatic, however it certainly can be: death, abuse, neglect, abandonment (trauma). It can be something quite minor: mom returns to work, mom is in hospital having another baby, mom is concerned with her ailing parent. It can also be a trauma or attachment event that happens before you were old enough to remember. Adoption is a one example. 
  3. Regardless of your genetics or your childhood experience, there are three major factors that turn these into a phobia, and keep the phobia going: 

I believe that one of the reasons that the fear of vomiting presents as so severe in most cases is that we naturally “avoid” vomiting throughout our lives. It just doesn’t happen that often. Young children vomit more often as their gut has not yet fully developed. But by about 13 your gut is an “adult” and you may only vomit once every 10 or 20 years. This kind of avoidance cannot be helped, so the factors of safety behaviours and anxious thoughts are  much more prevalent in keeping emetophobia going or getting worse. There are two types of safety behaviours, and there is disagreement among scholars as to whether both are problematic for emetophobia or just the first one:

  1. SAFETY BEHAVIOURS TO AVOID VOMITING
  2. SAFETY BEHAVIOURS TO AVOID PANIC (CALMING DOWN)

Let me begin by saying that I only believe that safety behaviours which avoid vomiting (germs, norovirus) are problematic, and behaviours to avoid panic and calm down such as slow breathing, muscle relaxation, etc. are a big part of the way out. 

Some common examples of emetophobia safety behaviours are:

  1. ​OTC medications (Dramamine/Gravol, Pepto Bismal, Tums)
  2. Prescription medications (Zofran/Ondansetron, Ativan, Xanax)
  3. Ginger, gingerale, ginger tea
  4. Mints, gum
  5. Sipping water
  6. Excessive cleaning (bleach)
  7. Excessive hand-washing or using hand sanitizer
  8. Not touching doorknobs, light switches, gas pumps
  9. Not touching your face
  10. Running away/avoiding sick people

There can be any number of others. The problem is that as soon as you employ a safety behaviour and don’t vomit, your brain will assume that the safety behaviour “saved you” and the situation was actually a dangerous one that you avoided this time. In reality, the situation wasn’t dangerous at all, because vomiting isn’t dangerous. Nobody likes it, but it’s actually helpful to you as opposed to a danger to you.

SLOW, DEEP BREATHING, relaxing large muscle groups, meditation, or imagining yourself going through a situation like a “normal” person are behaviours used to calm oneself and I do not consider them safety behaviours. Some schools of thought disagree with me, but I’m not alone in this idea. Learning to truly relax in the face of what I once considered was danger, was the way I got over my phobia.