Let's Talk About ... Um ... Erections

How to Respond Appropriately and Professionally


When I was in massage school, my classmates and I spent days and nights learning about the anatomy of the body, memorizing information about bones, muscles, nerves, and organs. Yet there was one body part that was left out—the penis. We didn’t talk about it, because as future massage therapists, we certainly weren’t going to be touching or massaging that body part. 

We did discuss erections, but only briefly. Our teachers said if a client has an erection but behaves appropriately, and the therapist feels comfortable continuing with the massage, then the therapist should continue. However, teachers said if the client displays inappropriate behavior, then the therapist is fully entitled to stop the session. This approach and philosophy seemed quite simple and eliminated confusion and worry about future clients for us as students. Yet, after nine years of working as a massage therapist, I have found that what ends up happening to the penis during normal, therapeutic massage can be a topic worthy of discussion.

By examining how the penis and erections have been viewed at other times in history, by other cultures, and by science, perhaps we can break through some of our modern American societal taboos surrounding the subject.

Beyond Fear and Myth

The topic of erections is not only complicated, but also rarely addressed. During therapeutic massage, erections can be annoying, embarrassing, and sometimes ridiculous. I asked other massage therapists in my Portland, Oregon, community about this topic, but received hardly any replies to my questions, so I reached out to other massage therapists across the country. 

I posted an inquiry on ABMP’s social media site, www.massageprofessionals.com, asking how massage therapists deal with the occurrence of erections during therapeutic massages. There are more than 11,000 massage therapists listed as members on this site, which is described as “an open community for all massage therapists.” I received responses from 12 massage therapists. Eleven out of the 12 said that as long as the client is displaying appropriate behavior, they ignore erections. One therapist said she has a zero-tolerance policy for erections. 

Several of the responses, though, bemoaned how erections are still a taboo topic in the professional world of massage. Gerry Bunnell, a massage therapist in Bumpass, Virginia, wrote, “I feel it would do our profession well to have very open and frank conversations about it instead of shying away from the subject over fear of impropriety. It is an extremely important subject that I feel many therapists are not trained to deal with compassionately and appropriately.”

Our society’s view of erections involves fear and myth. A massage therapist who blogs anonymously at The Real Rub—Life as a Massage Therapist writes, “I get asked about erections regularly by both men and women. Fear of getting an erection [during massage] is a powerful deterrent for men. Some aren’t comfortable getting massage from a man because they’re afraid ‘it will move,’ and some simply won’t get massages at all for the same reason.”1 

I have also talked with men in social settings, outside of the massage office, who have admitted that they avoid getting massages because they are worried about having an erection. Lorine Dolby Hoffer, a massage therapist who splits time between the Washington, D.C., area and Park City, Utah, says, “I think it’s a really important subject, and I think both men and women are highly uncomfortable with it. It keeps people from actually seeking massage.” 

Historically Speaking

To break loose from our societal taboos, let’s take a few steps back and examine the cultural history of the penis. In his book A Mind of Its Own: A Cultural History of the Penis, David Friedman writes that one specific moment in history when the sexual male form was celebrated was in Greece around 500 BCE. Most Athenians displayed their admiration of masculine power with statues, called hermae, outside their front doors. According to Friedman, hermae were “stone or wood columns topped by the head of the god Hermes and marked at the midpoint by an erection.”2 Friedman also writes about the widespread prevalence of sexual male imagery in ancient times: “Like Athens, depictions of erections were everywhere in Rome—on paving stones, at the public baths, on the walls of private homes—promoting good luck or warding off bad.”3 

According to Friedman, the Greeks and Romans did not attach our modern associations of shame or guilt to the naked male form and erections. “For the Greeks and Romans, an erection was like a change in heartbeat; involuntary, and not susceptible to blame or praise,” he writes.4 But in the fifth century, there emerged a philosopher and theologian from the Roman Empire named Augustine. Augustine is generally considered to be one of the greatest thinkers in all of history, and his writings were very influential in the development of Western Christianity. Augustine became the Bishop of Hippo and exerted strongly negative views of erections and semen. Elaine Pagels, a Princeton professor of religion and author, writes that Augustine’s views became “the dominant influence on Western Christianity, both Catholic and Protestant, and color all Western culture, Christian or not.”5 Augustine’s influence was far-reaching and long-lasting. Friedman, citing Pagels, writes, “But for Augustine the cause and the effect of original sin is lust, the symptom and the disease is the erection. With this one stroke, this one man transformed the penis more than any man who had yet lived: the sacred staff became the demon rod.”6 

In addition to the historical and cultural background of the penis and erections, there is also the scientific side of erections. Pia Poulsen, a massage therapist living in France, maintains a blog called Massage and Wellness. After writing about massage and nudity, she received many questions about involuntary erections and ejaculations during massage. “It is one of those questions only a very few dare ask openly,” she writes. “When a person receives a massage and trust exists between the therapist and client, oxytocin is released into the blood. High levels of oxytocin can lead to erections and, in some cases, ejaculation (the hormone is needed for the contractions during an ejaculation).”7

Poulsen’s conclusion is supported by Roy Levin, PhD, a behavioral scientist who wrote in the academic journal Sexual & Relationship Therapy: “It has been known for many years that oxytocin, ADH (antidiuretic hormone, or vasopressin), and prolactin were released from the posterior pituitary during human sexual arousal.”8 Yet, despite these assertions, there are still no fully complete or agreed-upon scientific explanations for the mechanism of erections. According to Arthur L. Burnett, MD, director of the Male Consultation Clinic at Johns Hopkins University, “Our understanding of erections has gone through a long evolutionary process. Much of our scientific information about erections is less than 200 years old. A lot of it less than 20 years old.”9

A Matter of Fact

So what is the client’s experience when he has an erection on a massage table? The anonymous author of The Real Rub writes, “In my experience, the man is more mortified than I could ever be. As a matter of fact, I had one client tell me, ‘I can’t have you work on my thighs anymore. You can work the knees and below, my hamstrings, my calves, but not my thighs. They are very sensitive, and I am horrified I might get an erection. I can’t relax.’”10

I contacted a few men who are regular massage recipients and asked them about their experiences. David Bakke, editor of a financial website, uses a mental trick to make an erection go away. “As crazy as it may sound, I think of retirement planning,” Bakke says. “It’s a constant source of concern in my life right now, so thinking about that usually makes it go away quickly.” 

Pat, an officer in the military, says that it is touch alone, not any bad intentions, that contributes to erections during his professional massages. “I’ve never had feelings about any of my therapists,” he says. “Just the physical touch, especially in areas like the inner thigh, can cause the erection. Most times I don’t really realize I have an erection, or I’ll have a slight feeling, and then I’ll look down there and realize it’s popped up.”  


Our job as massage therapists is to help people integrate into their bodies. We are here to help people not only heal from physical pain and injury, but also from emotional traumas that can be held in the body. We are here to accept clients’ bodies so they can accept their whole selves. While erections may be an uncomfortable topic to address in the context of a professional massage, we as massage therapists should practice enough understanding and empathy to encourage well-behaving, well-intentioned clients to return to the table. 

We need to remember that erections are usually not about the practitioner. They just happen. 


1. “Question: What If I Get an Erection?” The Real Rub—Life as a Massage Therapist (blog), accessed February 2013, http://therealrub.wordpress.com/?s=erection.

2. David Friedman, A Mind of Its Own: A Cultural History of the Penis (New York: The Free Press, 2001): 18.

3. Ibid, 25.

4. Ibid, 39.

5. Elaine Pagels, Adam, Eve, and the Serpent (New York: Random House, 1988): 150.

6. Friedman, 39.

7. Pia Poulsen, “Involuntary Erections and Oxytocin in Massages,” Massage and Wellness: For Clients and Therapists Alike (blog), accessed February 2013, http://blog.starkeys.com/lang/en-uk/2010/04/involuntary-erections-and-oxytocin-in-massages.html.

8. R. Levin, “Is Prolactin the Biological ‘Off Switch’ for Human Sexual Arousal?” Sexual & Relationship Therapy 18, no. 2 (2003): 237.

9. Friedman, 258.

10. “Question,” The Real Rub.


Let’s Hear It
From the Guys

We asked a small sample of male massage clients about getting an erection during a therapeutic session. Here are their anonymous responses.


If I got an erection during a massage, I wouldn’t want the massage therapist to address it at all. That would make the problem much worse and make for an uncomfortable experience the rest of the session. Best for both parties to just ignore it.



There’s a reason why I wear underwear when I get a massage. That means that’s a no-massage zone. I don’t want to risk it happening. 



I like a proactive approach. If it is the therapist’s first time with me as a client, I think addressing the issue beforehand by saying something like “massaging muscle tissue can sometimes cause sexual arousal and in such situations there’s no need to be embarrassed. I am a professional massage therapist and I only want you to be relaxed and at ease.” That’s it; no more talking.



I would never get any massage beyond a chair massage ever again if I got an erection during a table massage.



I would have to say something. I couldn’t just ignore the elephant in the room and wonder if she was thinking that I had ill intentions. I would probably apologize to the MT to let her know that it wasn’t done on purpose and hopefully she wouldn’t feel uncomfortable or threatened.



I think I would want the MT to approach it with a sense of humor. Better to make a (tasteful) joke than for us both to be holding our embarrassment for the rest of the session. If it turned into an awkward situation, I’d probably be less inclined to rebook.


Arousal Responses from clients

By Anne Williams


Therapists have a variety of reactions when their clients get an erection during the session. Some overreact and shame the client by terminating the session or speaking in judgmental tones. Others respond with paralyzing fear and embarrassment. It’s important to remember that the arousal response is normal, and with a few simple changes in technique, it is likely to pass and the session can continue. 

Notice your client’s face. Is it flushed and embarrassed, or is he deeply relaxed? Sometimes a client is so relaxed that arousal happens without full awareness. If this is the case, you might simply change techniques and not need to address the situation verbally. If the client is embarrassed, it is appropriate to be reassuring. One therapist tells embarrassed clients, “This is a normal response. No worries. Would you like an extra blanket?” 

Indeed, additional draping material (e.g., an additional towel or blanket) can create a thicker physical barrier and give a greater sense of privacy. 

Change the massage techniques to those that are more invigorating, such as stretching, joint movements, or vigorous compression or tapotement. These types of techniques stimulate a sympathetic response from the body, and can help arousal pass. 

Move away from the legs, gluteal muscles, or abdomen and focus on areas not associated with the sacral or lumbar nerve plexuses. Often it is appropriate to simply turn a male client into a prone position and work on his back, neck, and shoulders. 

If the client indicates by his verbal or nonverbal behavior that he has sexual intent, end the session immediately and terminate the therapeutic relationship. 

It is common to feel threatened, awkward, and embarrassed when confronted with sexual arousal responses during a session. The best way to prepare is to practice. Plan the words you would use, and practice these words out loud. As you practice, you may start to notice that the emotional triggers caused by these words decrease in intensity. It is also helpful to role-play these scenarios with colleagues. It can feel embarrassing at first, but when you get over the embarrassment you know you are building the skills you need to manage sexual arousal responses and maintain a healthy therapeutic relationship with clients. 

Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012). This passage was adapted from Massage Mastery. She can be reached at anne@abmp.com.

To read the this article in our digital issue, click here.