Dear Alice,

Under times of heavy stress, high anxiety situations, and physically strenuous activity (especially running), I tend to gag and dry heave. When I am at rest, this never happens. I even gagged in class at my last mid-term because I was nervous about the test. This did not start until I was 18 years old and when I joined the military. I am 27 now.

I no longer wish to be this way. The military doctors said that I just have a sensitive gag reflex. Well, this is not normal; it's too sensitive. I would like to be a normal person and not gag in public when I get nervous or have to speak in front of large crowds. Do you have any idea what is wrong with me? My wife says that I need to have my tonsils taken out, but she is not a doctor. Gagging during sex is a big mood killer for her also, but the high excitement and physical activity just tightens my throat and I get choked out. Please help. What do I need to do?

Dear Reader,

Experiencing stress can be challenging at any time, but adding the feeling of having to gag can make your discomfort that much worse. The gag reflex, which is an evolutionary mechanism to help prevent humans from choking and ingesting potentially harmful substances, works by causing the back throat muscles to resist swallowing. Overactive gag reflexes can be tied to anxiety and stress. As you've mentioned, it's best to have the condition checked out by a health care provider because it could be tied to other health issues, as minor as acid reflux or as serious as multiple sclerosis. 

If not associated with an underlying health problem, the gagging you're experiencing may be due to stress and anxiety. In fact, gagging and dry heaving can manifest itself for many reasons, including:

  • Panic attacks brought on by stressful situations, such as tests and public speaking
  • Unpleasant odors, such as sulfur from rotten eggs
  • Intense physical activity, including sex
  • Sensitivity to certain foods and liquids to which you might be allergic

Some options for the short term include topical benzocaine gel, which can temporarily numb the area. However, it's critical to keep in mind that this isn't recommended as a long-term solution. For long-term solutions, you may want to discuss options with your health care provider to alleviate your feelings of anxiety and stress. In addition, empirical evidence shows that temperature-controlled radiofrequency can desensitize the general area responsible for the gag reflex. Radiofrequency ablation (RFA) is a procedure that uses an electrical current produced by a radio wave to heat up a small area of nerve tissue, thereby decreasing pain and sensitivity from the specific area in question.

All in all, you may find that your best option is to go back to your health care provider and seek further advice. You may also find it helpful to seek a second opinion if you found your previous health care providers to be unhelpful. Additionally, you may want to reach out to a mental health professional, who will be able to help you cope with your feelings of stress and anxiety that are stirring up this gagging feeling. If you seek their assistance, sharing how gagging negatively impacts your day to day life may help them better understand what you're experiencing. While gagging may not be associated with an underlying issue and may be unpleaseant, it can still be impacting your relationships and mental health, so it can certainly be worth exploring further with different providers. In the meantime, feel free to check out the Stress & Anxiety section of the Go Ask Alice! Emotional Health archives for more information and strategies for coping with stress. 

Take care,

Alice!

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