Note: Most erections during massage are involuntary, normal physiological responses and do not indicate sexual intent. In the vast majority of cases, no verbal intervention is necessary, and the focus should remain on providing a safe, professional, and therapeutic session. This article provides guidance for the rare situations where intent is unclear or inappropriate behavior is observed.
Normal Physiological Reactions in Massage Therapy
Erections during massage are a common physiological response for clients with male anatomy, and they can occur regardless of whether the practitioner is male or female. While an erection reflects a physiological response to touch via the parasympathetic nervous system, it does not necessarily indicate sexual desire or intent. These responses are involuntary, normal, and can occur without the client having any control over them. Maintaining professional boundaries and focusing on the therapeutic session is typically sufficient unless there is clear evidence of inappropriate sexual behavior.
Physical arousal can occur in clients of all genders, though it is often less visible in women. Fear of experiencing an involuntary erection, or concern about how a practitioner might respond, can lead some men to avoid therapeutic massage altogether. Providing education about the normal, involuntary nature of these physiological responses can help clients feel more comfortable and confident in seeking somatic-based therapies.
If there is any discomfort on the part of either the client or the practitioner when an erection occurs, it must be addressed.
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Discomfort on the part of the client or the therapist will divert the focus of the therapy, resulting in decreased effectiveness.
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If a client shows no signs of embarrassment or discomfort due to their erection, and the therapist is comfortable, then addressing it is not necessary.
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If the therapist notices any client discomfort, such as body tension or facial flushing, then it would best serve the client to talk about it.
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Because the antidote to a parasympathetic response is activation of the sympathetic nervous system, changing the technique being used can quell a spontaneous erection.
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The sympathetic nervous system can be activated by increasing massage pace and pressure. Note: This increase should be moderate, as it is not intended to alarm or cause pain to the client.
The Intervention Model
Managing Erections During Massage: When and How to Intervene
Based on fundamental communication skills, Daphne Chellos’s framework “The Intervention Model,” as presented in The Ethics of Touch by Ben E. Benjamin, Ph.D., and Cherie Sohnen-Moe, provides eight flexible steps to guide a practitioner’s action when a client’s intent is unclear. Depending on the circumstances, it may be necessary to proceed through the steps consecutively, pause early, change the order, or skip some.
While these steps are valuable for situations where a client demonstrates inappropriate or concerning behavior, it is important to recognize that involuntary, parasympathetic responses such as erections are normal and often do not require intervention.
The following outline has been adapted for addressing erections during massage when intent is uncertain:
Step One: Stop the treatment using assertive behavior
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Address the client with body language that matches your verbal communication to demonstrate professionalism and assertiveness.
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Tips to remain assertive include making eye contact when possible, standing with a relaxed yet grounded posture, and using a firm, calm voice.
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Avoid shrinking or speaking quietly, which can appear passive, and avoid yelling or touching inappropriately, which can appear aggressive.
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Adjust the drape to ensure proper coverage, which confirms professional boundaries and helps the client remain comfortable if an erection occurs during massage. For involuntary physiological responses without inappropriate intent, no verbal intervention is necessary, though adjusting the drape can help maintain comfort.
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Maintaining safety is always a priority. If the therapist feels threatened or notices inappropriate behavior, position yourself with easy access to an exit and proceed according to professional judgment.
Step Two: Describe the behavior
When a client’s intent is unclear, describing what you notice can clarify the situation without passing judgment. This helps the client know you are paying attention while maintaining professionalism. Examples of this type of communication include:
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“I notice you’re tightening your muscle and grimacing when I pass over this area.”
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“I am aware that you made a comment about my appearance, then made a sexual joke, and now you have an erection.”
Note: For involuntary physiological responses that appear normal and without sexual intent, verbal description is often unnecessary. Use this step only if there is ambiguity about the client’s intentions or if inappropriate behavior is suspected.
Step Three: Clarify the client’s intent
If the client’s intent remains unclear after describing the behavior, you can ask a simple, direct question to understand what they are experiencing. Examples include:
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“Can you tell me what’s happening?”
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“What are you experiencing?”
Depending on the client’s comfort level and their intent, a client’s response to an erection during massage may or may not be straightforward. It is important to resist providing an answer for the client, so wait for a clear response. Clarification of the client’s intent allows the practitioner to render an accurate assessment.
Step Four: Educate the client
During a somatic-based therapy, some clients may experience unexpected emotional or physiological responses. If the client shows concern, embarrassment, or asks about the response, the therapist can provide reassurance and education. Examples of educative statements include:
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“Sometimes the body responds physiologically to touch. This is a normal bodily reaction”
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“It’s natural for some clients to have a physical reaction to massage.”
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“I noticed you had an erection during the last massage. I want you to know that erections during massage are usually just a physiological reaction and not unusual.”
Step Five: Re-state your intent
If you feel that the client’s intent is still unclear, you can reinforce safety and professionalism by clarifying the therapeutic purpose of the session. Examples include:
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“It is never my intent to create sexual arousal during a session. If it happens and I’m confident your intent isn’t sexually inappropriate, then I’m comfortable in continuing the session if you are.”
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“I want to make it clear that this is a non-sexual massage. I will end the session if you are looking for something else.”
Step Six: Continue or discontinue the session as appropriate
A client displaying sexual intent or inappropriate behavior requires immediate termination of the session.
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If sexual intent is clear, there is no need to employ the previous steps; end the session politely and professionally.
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If the client’s intent remains unclear, you can establish conditions to maintain comfort and safety. For example:
“I will continue with this session, but will stop if your behavior causes me to feel uncomfortable in any way.”
Step Seven: Refer client to other professionals as appropriate
If you believe a client could benefit from professional support — for example, a psychotherapist, counselor, or other medical practitioner — provide referral information once the session is complete and the client is fully dressed and alert. This ensures that the recommendation is delivered respectfully and professionally.
Step Eight: Document the situation
After the client leaves, document the occurrence and obtain supervision or peer support as necessary. Difficult communication with a client can raise ethical questions or safety concerns, and seeking supervision demonstrates a commitment to professionalism and ethics. A neutral party can provide a reality check or needed emotional support.
Unless you fear for your own or someone else’s safety, client confidentiality must be honored. When documenting the situation, include all relevant facts, including your own actions. This is vital should a client ever lodge a complaint.
Physiological responses that are involuntary, normal, and without sexual intent generally do not require documentation. Document only when intent is unclear, inappropriate behavior occurs, or additional oversight is warranted.
Conclusion
Encountering erections during massage as a physiological response to parasympathetic arousal is common in massage therapy. Addressing this professionally requires preparedness, maturity, and clear communication. It is important to recognize that an erection may be an involuntary physiological response and not a sign of sexual intent. By distinguishing between normal body reactions and inappropriate behavior, therapists can maintain professionalism, ensure safety, and reduce client embarrassment. Open communication about therapeutic intent and the physiological normalcy of erections helps preserve ethical boundaries while maintaining respect for the client. With education, confidence, and clear strategies in place, therapists can navigate these situations while protecting both their clients and themselves.
Originally posted December 2005. Updated August 17, 2025.
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