Underwear Policies: Is Wearing Underwear Option, Mandatory or Required During a Massage?

By Selena Belisle, CE Institute LLC Founder & Instructor

The answer is, it depends where you are, and perhaps even what type of service is being provided. In this article, when we mention underwear, we mean bottom underwear only, over a client’s genitals and cleavage of the buttocks.

The other day I had a massage on a cruise ship, and they require all genders to leave their underwear on as a matter of company policy for spa services and massage, per what I was told by the practitioner on the cruise.  Each massage establishment has the right to create their own service and appointment policies. There is no universal massage governing body that oversees these types of practices or policies. Requiring clients to leave their underwear on is a reasonable policy made up by individuals and/or establishments, especially when specific hip work has not been requested, and when the massage therapist is constantly seeing new clients for a one-time appointment, where a regular client-therapist relationship is not established on a long-term basis.

Requiring underwear during a massage appointment could be required for several reasons:

1. The most popular reason is to address one of the largest problems in today’s modern massage industry, being clients seeking sexual services under the guise of massage. Hopefully a business’s underwear policy of requiring them to remain on during a massage, will deter perverts and criminals seeking illicit and illegal practices instead.

2. There are also an alarming number of sexual assault claims being made by clients during professional massage practice. Requiring clients wear underwear as a matter of company policy will hopefully provide a physical barrier of deterrence to such assault. Please note that there are former licensed massage therapists sitting in jail right now from sexually assaulting massage clients on their table. While America is what most would refer to as a litigation driven country where anyone can make any claim and sue over it, there are very real sexual assaults that have occurred during massage therapy practice where better policies could hopefully help prevent such horrid acts of crime. 

3. Underwear provides a physical boundary that might allow the client to feel more comfortable during their massage appointment, especially if they’re already uncomfortable with getting naked and having a "stranger" touch them for a professional massage appointment, especially when they’re new to the therapist.

4. Underwear also provides a clear boundary of where gliding strokes with massage medium will start or stop when working on the low back, lower abdomen or upper legs, unless the therapist ends up soiling the client’s underwear by running massage medium over their underwear, which is not recommended.

5. It usually provides an extra barrier of comfort or warmth for the client, beyond regular draping. This might be more important if you work in excessively and uncontrollable colder climates where there are too many client complaints about being too cold during a massage. In this case, you should also have extra blankets and/or table warmer to help a client feel comfortable.

Some companies require a client to wear underwear and some do not.  Some companies have no policy whatsoever, and it’s up to each individual practitioner or establishment to address this issue.  If you’re developing a client underwear policy in your own practice or establishment, we feel the policy should be universal regardless of gender, whether it’s a male therapist working on a female client or male on male, etc.  Otherwise, someone could claim sex discrimination if the policy were to change or revolve around a practitioner or client’s gender.

Conversely, it is a client’s choice to wear or remove their underwear during a massage appointment, as long as the provider or establishment allows for their removal.  If a client wishes to remove their underwear during a massage appointment, then they should inquire about this policy BEFORE they make their massage appointment.  Once a client schedules a massage appointment, it is their responsibility to honor the practitioner and/or establishment’s service requirements.  As such, if there is a policy about client underwear, it would be important to publicly post this policy information on a company website and in other reasonable public places where policy information or FAQs can be found.  Please keep in mind that underwear and draping are two totally different issues, and professional draping practices are not addressed nor covered in this article.

For regular massage with a massage medium such as oil or cream, it is possible that the client’s underwear could be soiled with the massage medium if they’re left on during the session.  A therapist can help avoid this soiling by tucking the draping into the client’s underwear, which will help the draping absorb the massage medium, as long as the therapist has the client’s permission to do so.  Touching or moving a client’s underwear could have its own implications where a client could claim something improper happened, whether it did or not.  Anyone can claim anything - that’s just how the world works these days. As such, it’s extremely important to ask the client’s permission to tuck the draping into the client’s underwear before doing so. Therapists should always respect client’s boundaries, and asking a client’s permission to tuck the draping into their underwear is showing that respect.

Underwear policies are decisions that establishments and massage therapists must make and be satisfied with before providing massage.  If a therapist does not like an establishment’s policies, they can either address these with management to seek change, or seek employment elsewhere. When employed by others, it’s important to honor and follow a massage establishment’s policies while practicing, so that a therapist is not considered to be noncompliant or insubordinate.

Sometimes deep tissue work, petrissage or other massage techniques on the hip would be best employed while working on bare skin.  If a client is seeking hip work, or hip work is recommended by the massage therapist, it would be important to address any underwear policy prior to scheduling their appointment, to make sure you are on the same page as to how the appointment will be executed. Hip work can be extremely valuable when it is needed. This area should not be overlooked when a client presents with low back, hip, upper leg or other pain, etc.

If a client has had hip work on their bare skin from another massage therapist and is expecting the same from you, then that client could be disappointed to show up and be told they will need to leave their underwear on.  While hip work can be provided with compressive bodywork and other techniques through the client’s underwear or draping, it’s really up to a client to choose what type of hip work they want, within a practitioner’s skill level, offerings and abilities, and the therapist or establishment must disclose any policies regarding hip work and draping, ideally before the appointment is scheduled or executed.

If a massage therapist is used to providing hip work on bare skin, they contrarily cannot force a client to remove their underwear. That would be considered unethical and an abuse of power differential, amongst other possible nefarious practices. This is why it would be important to post policies publicly and review a new client’s goals, then provide practical procedures to a client, prior to scheduling their massage appointment. At the very least, reviewing practical procedure and company policy should be provided to the client as a matter of informed consent before any appointment begins, even if they’re already in your treatment room and no chance was provided to review this information beforehand.

Massage clients always retain the right to remove as much or as little clothing as they wish, and then it’s up to the massage therapist to determine how to provide the scheduled appointment.  Providing dry compressive massage through clothing or draping should always be an option for a client who is uncomfortable undressing for an appointment, as long as the compressive therapy is not for an excessive period of time where pressing into the same area could cause more harm than good, or if there are other exceptional reasons why such an appointment cannot be provided. Massage therapists conversely need to reasonably inspect a client’s skin prior to providing compressive bodywork through a client’s clothing to avoid pressing on unknown bruises or infectious disease as well. Therapists should always ask a client’s permission before lifting a client’s clothing to visually inspect the soft tissue being worked on, or ask the client to expose the treatment area first for visual inspection, prior to working on it.  And of course, a therapist should never ask a client to expose their genitals for massage or bodywork, which is considered to be an abuse of power if not a criminal act.

There are very few times where removing underwear should be paramount for therapeutic benefit; however, I can think of one medi-service when underwear should be removed for a mechanical style of massage. In endermologie practice, a treatment head is glided over a client’s body to suction the skin into the roller head. This mechanically rolls the skin similar to myofascial skin rolling, which most would consider to be soft tissue manipulation or mechanical massage.  The purpose of endermologie is to stretch the underlying collagen fibers and anchoring fibrils for benefits such as increasing circulation or temporarily reducing the appearance of cellulite.

Endermologie clients are provided a body stocking to wear during endermologie service (as pictured above and below), so while they remain covered by this body stocking, it would be important to remove all other undergarments so that the roller heads can maintain the best possible suction and contact with the client’s skin. However, in an interesting new practice, one cruise ship line is offering paper panties to wear under a woman’s endermologie suit for privacy. These paper panties are thin, minimal and can be pulled into a thong along the buttocks, but also provide a physical barrier to help hide pubic hair with the white see-through stocking. 

Endermologie practice traditionally offers grey suits to men (pictured below) and white suits to women (pictured above), with the white suits being more transparent.  At the beginning of endermologie practice decades ago, it was most provided by female practitioners probably over 95% of the time.  However, as endermologie practice became more popular, there was an increase of male endermolgie practitioners, and as such, female clients probably felt more comfortable with the paper panties under their endermologie suits so that their private area was less exposed to the endermologie practitioner.

Spa services such as body scrubs provided by massage therapists may also recommend a client to remove their underwear to prevent soiling their undergarments.  In these instances, if an establishment wishes to maintain an underwear policy, we recommend providing disposable paper panties to the client to use in place of their underwear, or allow a client to keep their underwear on while knowing they could be potentially soiled by massage or spa product during the treatment. Paper panties are traditionally wrapped as pictured below.  They are sold as one size fits all, however, I usually joke with my clients that these are one size fits no one. They are inexpensive and should be discarded after use.

If a massage therapist is somehow still practicing after an inappropriate client contact claim is made against them, then I would recommend installing a policy to require underwear to remain in place during massage appointments.  This is just one added protection that if practiced 100% of the time with all clients, might help a therapist show that protections are in place if a falsified or erroneous claim of sexual contact is made. Of course, sexual contact can happen when a client’s genitals are purposely touched through underwear or draping; however, requiring underwear to remain in place is one extra barrier that will hopefully deter inappropriate contact or a false claim.

If wearing underwear during massage appointments is chosen or a matter of policy, it’s important for a practitioner to never work underneath a client's underwear.  The underwear are there for a reason, which is usually to provide a physical boundary beyond other benefits such as extra warmth for the client. Reaching or working underneath that physical boundary is VIOLATING the boundary, which should be avoided at all times for propriety. 

There’s a lot to consider when developing policies about underwear during massage practice.  To our knowledge, there is no state, country or municipality that has developed law regarding this issue, as this is more of a private business decision between practitioners and clients.  

I do not believe there is any right or wrong answer as to a massage underwear policy, as long as the client’s therapeutic needs are met while everyone remains comfortable and safe.  Massage therapy is something that should be enjoyable, so providing it in a manner where a client’s goals plus therapeutic benefit with comfort and safety are all met simultaneously should be paramount.

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