Whether you remove your underwear for a massage is entirely up to you, and a skilled therapist will work around whatever you choose to wear. Most spas and massage clinics tell clients to undress to their “comfort level,” which means some people strip down completely and others keep their underwear on. Neither choice is unusual, and your therapist has seen both countless times. The real question behind the question, though, is usually about what’s normal, what’s expected, and what actually affects the quality of the massage.
What Therapists Actually Expect
Licensed massage therapists are trained to be neutral about what you’re wearing under the sheet. When they step out of the room and tell you to undress to your comfort level, they mean it literally. Some clients leave everything on; some keep underwear on; some remove everything. None of these choices is a problem for the therapist, and none of them is “wrong.”
The reason therapists use that specific phrasing is rooted in professional ethics. Through consensus processes involving practitioners, ethicists, legal experts, and public representatives, the complementary medicine field has developed formal ethical rules for boundaries of touch, and a core principle is that the client’s autonomy over their own body is non-negotiable.1PubMed. Development of ethical rules for boundaries of touch in complementary medicine–outcomes of a Delphi process If a therapist ever pressures you to remove more clothing than you’re comfortable with, that’s a red flag, not standard practice.
In practice, the therapist leaves the room while you undress, you get under a sheet or blanket on the table, and they knock before re-entering. They never see you fully uncovered regardless of what you have on underneath. The draping system is specifically designed so that the question of underwear barely matters from their end.
How Draping Works and Why It Matters More Than Underwear
Draping is the practice of keeping you covered with a sheet, towel, or blanket during the massage, exposing only the area being worked on at any given moment. When your therapist works on your back, your legs are covered. When they move to your legs, your back is re-draped. Genitals and, for women, breasts are always covered.
This system exists precisely so that the underwear question becomes low-stakes. If you’re wearing underwear, the therapist tucks the drape around it. If you’re not, the drape itself serves as the boundary. Either way, you’re covered, and the therapist adjusts their technique accordingly. Draping isn’t just etiquette; in most U.S. states, it’s legally required for licensed massage therapists. Other countries have similar rules, though the specifics vary.
The one practical consideration is that draping around underwear can sometimes limit how far the therapist can work into the gluteal muscles or hip area. If you’re getting a deep-tissue massage specifically targeting your lower back or hip flexors, removing your underwear gives the therapist a bit more range. But it’s a matter of degree. A good therapist can still do effective glute and hip work with your underwear on by tucking the waistband down slightly or working through the drape.
When Keeping Underwear On Makes a Real Difference
For most massage types, whether you keep underwear on has virtually no impact on the session. A Swedish relaxation massage, a shoulder-and-neck focused session, or a sports massage targeting your calves and quads won’t be affected at all. The therapist isn’t working anywhere near your underwear line for most of those treatments.
There are a few situations where going without underwear genuinely helps:
- Deep hip work: If you have piriformis syndrome, sciatica-like pain, or chronic tightness in the hip rotators, your therapist may need to work the muscles deep in the buttock. Underwear, especially briefs or bikini-style, can get in the way.
- Full-body hot stone massage: Stones placed along the spine and sacrum work better against bare skin, and an underwear waistband can interfere with stone placement on the lower back.
- Body wraps or scrubs: Spa treatments that apply product to your entire body are messy. Keeping underwear on means the product gets on your underwear, and then you’re wearing damp, oily underwear afterward.
- Thai massage or stretching-heavy sessions: These are actually the opposite case. You typically stay fully clothed in loose, comfortable clothing for Thai massage, so underwear isn’t even a consideration.
For everything else, the difference is marginal. If you’re worried about it, the simplest approach is to leave underwear on and tell your therapist to let you know if it’s limiting their work. They’ll tell you honestly.
What About Bras
For people who wear bras, the calculation is a bit different from underwear. A bra strap running across the back is a genuine obstacle for any back massage. Therapists can work around it, unclip it with permission, or slide straps aside, but the simplest solution is to remove it. Most people who wear bras do take them off for a massage, even if they keep underwear on. If you feel strongly about keeping your bra on, tell your therapist, and they’ll accommodate you.
Some spas provide disposable underwear or offer the option of wearing a provided garment. This is more common in destination spas, resort settings, and some Asian-style spas where treatments like body scrubs are the norm. If you’re unsure what a particular spa expects, calling ahead to ask is completely normal and not awkward for the front desk at all.
Gender, Comfort, and the Therapist’s Sex
Research on massage preferences shows that gender plays a significant role in how comfortable people feel during a session. A study examining the choice of male versus female massage therapists found that preferences are linked to multiple factors, including the client’s gender, the type of massage, and the client’s readiness to be exposed to and touched by an unfamiliar person of the opposite sex.2Journal of Hospitality & Tourism Research. Gender—a Crucial Neglected Element in the Service Encounter: An Exploratory Study of the Choice of Hotel Masseur or Masseuse This finding aligns with what therapists report anecdotally: many first-time clients, particularly men, feel more self-conscious about undressing when their therapist is a different gender.
If the gender of your therapist affects how comfortable you are undressing, you can request a therapist of a specific gender at almost any spa or clinic. This is extremely common, not rude, and the reception staff won’t bat an eye. You don’t need to explain your reasons. Some people have a preference based on pure comfort, others for cultural or religious reasons, and others because of past trauma. All of these are valid, and the industry is set up to accommodate them.
First-Time Massage Anxiety Is Normal
If you’re Googling this question, there’s a good chance you’ve never had a professional massage or have had very few. That’s worth acknowledging because the anxiety around undressing is almost always worse than the actual experience. Within about two minutes of the massage starting, most people stop thinking about what they’re wearing or not wearing because they’re focused on how the massage feels.
A few practical tips that can ease the nerves:
- Arrive early: Rushing into the room and scrambling to undress before the therapist knocks makes everything feel more stressful. Giving yourself five minutes to settle in helps.
- Speak up about pressure and areas: Your therapist would rather you say “lighter please” or “skip my feet” than have you lie there uncomfortable for an hour. The communication channel goes both ways.
- You can stop anytime: If at any point you’re uncomfortable, you can ask the therapist to stop, skip an area, or end the session. You are always in control.
The massage industry understands that vulnerability is baked into the experience. You’re lying mostly undressed in a room with a stranger touching you. The entire professional framework of draping, consent, communication, and licensing exists to make that inherently vulnerable situation feel safe. When it works as designed, the underwear question becomes the least interesting part of the session.
Trauma Survivors and the Right to Stay Clothed
For people who have experienced sexual abuse or domestic violence, the question of undressing for a massage carries a completely different weight. Research into trauma-informed massage practice specifically identifies the client’s autonomy to keep clothing on during a session as a key recommendation for working with survivors.3PubMed Central. Mental Health Impact of Massage and Massage Therapy for Survivors of Domestic and Family Violence and/or Sexual Abuse: A Scoping Review This isn’t about preference; it’s about psychological safety.
If you have a history of trauma and you’re considering massage therapy, you don’t owe your therapist an explanation of your history. You can simply say “I’d like to stay partially clothed” or “I’d prefer to keep my shirt on,” and a good therapist will work with that without asking why. Some therapists specialize in trauma-informed bodywork and are specifically trained to create environments where the client has maximum control over what happens and when. If this is your situation, seeking out a therapist with that specialty can make a real difference.
It’s also worth knowing that you can change your mind mid-session. If you start the massage fully clothed and realize you’re comfortable enough to remove a layer, you can say so. If you start without underwear and feel exposed, you can ask for a moment to put them back on. The session is yours.
Cultural Differences in Massage Norms
What counts as “normal” for massage undressing varies dramatically by country and culture. In Scandinavian countries and much of Northern Europe, nudity during spa and wellness treatments is common and unremarkable. German and Austrian saunas, for instance, are traditionally nude, and massage treatments in those settings often carry a similar expectation. In contrast, massage in many East Asian traditions is performed fully clothed; traditional Thai massage, Shiatsu, and Tui Na all typically happen with the client in loose clothing.
In the United States, the underwear-optional-with-draping model is standard. In the UK, practices are broadly similar to the U.S., though some therapists use towels rather than full sheets. If you’re traveling and booking a massage in an unfamiliar country, the easiest approach is to ask the front desk what’s customary before your session. Cultural norms around nudity and touch vary enough that assumptions can lead to unnecessary awkwardness on either end.
The historical reason Western massage developed such careful draping protocols is itself revealing. In the late 1800s, massage in Britain became publicly associated with prostitution after a series of scandals covered by the British Medical Journal. In response, the Society of Trained Masseuses formed in 1894 specifically to legitimize the profession, establishing a biomedical model that treated the body as a mechanical system rather than a sensual one.4Social Science & Medicine. Physiotherapy and the shadow of prostitution: the Society of Trained Masseuses and the massage scandals of 1894 Modern draping standards, professional codes of conduct, and the careful language around undressing all descend from that effort to draw a hard line between therapeutic touch and anything else.
What to Do With Your Underwear Decision
If you’re still unsure, the most common choice is to keep underwear on for your first massage and adjust from there based on how comfortable you felt. Many regulars who started that way eventually switch to going without, not because anyone told them to, but because they realized the draping made it a non-issue and the therapist could reach the hip muscles more easily. Others keep underwear on for every massage they ever get and never feel it limits anything. Both are completely fine.
The one piece of underwear etiquette that does matter: wear a clean pair. Therapists work close to your body for an extended time. Beyond that, the choice is yours, and a good therapist genuinely does not care which way you go.
Massage Types Where Clothing Rules Are Different
A few massage modalities have their own clothing norms that override the usual “undress to your comfort” guidance:
- Thai massage: Performed fully clothed in loose-fitting pants and a top, often provided by the spa. No undressing required or expected.
- Chair massage: Done in a specially designed chair, fully clothed, usually in a public or semi-public setting like an office or airport. Underwear is irrelevant.
- Ashiatsu: The therapist uses their feet to apply pressure while holding overhead bars. You’re undressed and draped like a standard table massage.
- Lomi Lomi: A Hawaiian tradition that uses long, flowing strokes often covering the full body. Traditional Lomi Lomi uses minimal draping compared to Swedish massage, with the therapist using a small towel rather than a full sheet. Some practitioners follow the traditional approach; others use standard Western draping. Ask beforehand if modesty is a concern.
- Lymphatic drainage: Uses extremely light pressure. Can be done over light clothing, and some therapists prefer it that way. Others use standard draping on bare skin.
If you’re booking a specific modality you haven’t tried before, asking the front desk or your therapist about clothing expectations before the session is always appropriate. Therapists appreciate clients who communicate because it means fewer awkward moments once the session starts and more time spent on the actual massage.
When the Therapist Asks You to Remove Clothing
There’s a clear line between a therapist saying “I can do better work in this area without the waistband” and a therapist pressuring you to undress. The first is a professional observation offered as information. The second is a boundary violation. If a therapist makes you feel that your clothing choice is wrong, is visibly annoyed, or touches areas you haven’t consented to, you have every right to end the session immediately. Report the behavior to the establishment’s management and, if warranted, to the state licensing board.
Licensed massage therapists undergo hundreds of hours of training that includes ethics, boundaries, and proper draping technique. The overwhelming majority are consummate professionals who respect your autonomy completely. But the profession’s ethical standards exist partly because the power dynamic between a clothed professional and a mostly-undressed client lying face-down is inherently unequal. Knowing your rights helps you relax into the experience, and the right to keep your underwear on, put it back on, or request any other accommodation is firmly among them.