Gastroenterology Guide

Emetophilia is a sexual fetish in which an individual is aroused by vomiting or observing others vomit. When emetophiles put emetophilia into practice by actually vomiting, especially on a partner, it is called a Roman shower, after the supposed frequent induction of vomiting at Roman feasts.

Some emetophiles find the act of vomiting arousing; for them, the sequence of “spasm, ejaculation, relief” in vomiting is erotically charged. Other emetophiles are aroused by seeing and/or hearing others vomit. Some desire a partner who will vomit on them, while others wish to induce vomiting in a partner, or even force them to vomit. (Wanting to be vomited on may be related to a desire to be dominated, while wanting to make someone else vomit may stem from a desire to dominate the partner - see erotic humiliation.) Of course, most emetophiles have more than one of these desires, in various combinations.[citation needed]

An online site[citation needed][unreliable source?] theorizes, “vomiting was probably something either arousing or frightening to emetophiles at some point … it aroused powerful emotions, and the emetophile called upon these emotions for the purpose of sexual gratification.”[cite this quote] Often emetophobia can, paradoxically, lead to emetophilia, or even a mixture of the two in which a person is afraid to vomit, but aroused by witnessing someone else vomiting.[citation needed]

In some cases, emetophilia is directly related to vorarephilia.[citation needed] The emetophile fantasizes that he or she is consumed by the person who is vomiting, and imagines him/herself as covered by the contents of the person’s stomach while within the stomach of the person who is the target of their fantasy.

Females show a slight predominance over males; the female-to-male ratio is 57:43 (Li and Kagalwalla, 2002). CVS occurs in all races but seems to disproportionately affect whites.

There is no set cure for Cyclic Vomiting Syndrome, but there are medications that can be used to treat, intervene in, and prevent attacks. There is a growing body of publications on either individual cases or experiences of cohorts of CVS patients. Treatment is usually on an individual basis, based on trial and error.

The most common therapeutic strategies for those already in an attack are maintenance of salt balance by appropriate intravenous fluids and; in some cases, sedation. Having vomited for a long period prior to attending a hospital, patients are typically severely dehydrated and suffer from massive volume depletion. Abortive therapy has limited success, but for a number of patients potent anti-emetic drugs such as ondansetron (Zofran) or granisetron (Kytril), dronabinol (Marinol), and more recently dextromethorphan may be helpful in either preventing an attack, aborting an attack or reducing the severity of an attack.

The prevalence of the condition is not clear. Two published studies on childhood CVS suggest nearly 2% of school age children may have CVS. However, diagnosis is problematic and as knowledge of CVS has increased in recent years more and more cases are emerging. This suggests a tendency for underdiagnosis, and thus the true figure may be higher.

CVS may be related to migraine, CVS sufferers have a much higher number of first degree relatives who have migraine than is the case in the general population. Some CVS sufferers have symptoms similar to abdominal migraine, but in others the relationship is far less strong and they can’t relate to migranous symptoms. Some sufferers obtain some relief from anti-migraine treatments, but they are not universally effective.

Charitable organizations to support sufferers and their families and to promote knowledge of CVS exist in several countries.

The cause of CVS has not been determined, there are no diagnostic tests for CVS. Several other medical conditions can mimic the same symptoms, and it is important to rule these out. If all other possible causes have been excluded a diagnosis of CVS may be appropriate.

There are established criteria to aid diagnosis of CVS, essential criteria are
A history of three or more periods of intense, acute nausea, and unremitting vomiting lasting hours to days
Intervening symptom-free intervals, lasting weeks to months
Exclusion of metabolic, gastrointestinal or central nervous system structural or biochemical disease e.g. individuals with specific physical causes (e.g. intestinal malrotation)

During episodes of vomiting, blood sugar, fluid-electrolyte balance, and acid-base balance will need to be monitored. Once formal investigations to rule out gastrointestinal or other etiologies have been conducted, these need not be repeated in future episodes (Lindley et al, 2005).

CVS differs from other forms of vomiting as it is an acute condition. Sufferers may vomit or retch six to twelve times an hour and an episode may last from a few hours to well over 2 or 3 weeks. Some people[who?]find it hard to conceive how anyone can vomit after that length of time, as the stomach will have emptied after the first few emeses. Acid, bile and (if the vomiting is severe) blood may be vomited. Some sufferers will intentionally ingest water to reduce the irritation of bile and acid on the esophagus during emeses. Between episodes the sufferer is usually otherwise normal and healthy. The median duration of an episode is 41 hours (Li & Fleisher 1999). In approximately half of sufferers the attacks, or episodes, occur in a time related manner. Each attack is stereotypical, i.e. in any given individual their timing, frequency and severity of attacks is similar.

Episodes may happen every few days or every few months. For some there is not a pattern in time that can be recognized. Some sufferers have a warning of an attack, they may experience a prodrome, usually intense nausea and pallor. The majority of sufferers, but not all can identify “triggers” that may precipitate an attack.

The most common are various foods, infections (such as colds), extreme physical exertion, lack of sleep, and psychological stresses both positive and negative.

During an attack a sufferer may be light sensitive (photophobic), sound sensitive (phonophobic) and may take on a semi-conscious state (Lindley & Andrews, J Pediatric Gastorenterol & Nutr 2005)

Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as both the act and the vomit itself are widely considered embarrassing; vomit is also difficult to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag containing absorbent material that solidifies the vomit quickly is available, also, making it convenient and safe to keep (leakproof, puncture-resistant, odorless) until there is an opportunity to dispose of it conveniently.

People who vomit chronically (e.g., as part of an eating disorder such as bulimia nervosa) may devise various ways to hide this disorder.

It is quite common that, when one person vomits, others nearby will become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an evolved trait among primates. Many primates in the wild will tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party also to vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may result in a number of party members vomiting nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture: Notorious instances appear in the films Monty Python’s The Meaning of Life (1983) and Stand By Me (1986), while, in the computer game Theme Hospital, it is referred to as a ‘vomit wave’ and can spread through the hospital quickly.

Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience “la purga” after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it. [3] It has been suggested that the consistent emetic effects of ayahuasca — in addition to its many other therapeutic properties — was of medicinal benefit to indigenous peoples of the Amazon, in helping to clear parasites from the gastrointestinal system. [4]

There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria.

An emetic, such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.

Self-induced
Eating disorders (anorexia nervosa or bulimia nervosa)
To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is, in general, considered better to ask for help before inducing vomiting)
Some people who are engaged in binge drinking will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as tactical chundering, or hitting the reset button. In the United States, it is known as boot and rally or pulling the trigger.
After surgery (postoperative nausea and vomiting)
Disagreeable sights, smells or thoughts (such as decayed matter, others’ vomit, thinking of vomiting), etc.
Extreme pain, such as intense headache or myocardial infarction (heart attack)
Violent emotions
Cyclic vomiting syndrome (a poorly-understood condition with attacks of vomiting)
High doses of ionizing radiation will sometimes trigger a vomit reflex in the victim
Violent fits of coughing, hiccups, or asthma
Nervousness
Performing physical activity (such as swimming) short time after a meal.

Vomiting can be dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the gag reflex and coughing will prevent this from occurring, however these protective reflexes are compromised in persons under the influences of certain substances such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia.