Massage and Sexuality

Therapists Get in Touch with Cultural Misconceptions

By Eleanor LaPointe, Ph.D, CMT

Originally published in Massage & Bodywork magazine, December/January 2000.

When I first contemplated entering a year-long massage training program in 1994, I hesitated for two reasons. The first had to do with finances. Would I have enough money to pay for training at a private center? Would there be a financial pay-off upon completion? The second reason for my initial hesitance, and the topic of this article, had to do with the reactions I was getting from people when I mentioned massage. While some thought the idea was wonderful and offered their bodies for “practice,” others seemed mildly shocked, bewildered and amused when I informed them that I might become a massage therapist. The association of massage with sexuality was clear. I became selective when deciding to whom I would divulge my new interest.

Despite my trepidations, I finally took the plunge. It was probably one of the best decisions I ever made. Financially, the investment in training was well worth it. Not only did I learn about health care, my own and others, but I have since managed to earn a living as a full-time massage therapist. However, the issue of sexuality or sexual stigma,1 as I have come to call it, still continues to haunt me. Many negative public perceptions about massage seem to have lessened even in the brief span of three years since I have been practicing. But as I continue to encounter massage students, established practitioners and the general public during my day-to-day routine, it is clear the issue is still salient. Why else would I become defensive when earlier this year my accountant innocently asked if I used machinery in my practice — “You know, like a vibrator?”

Perception as Truth?

I am not exactly sure just how widespread prostitution is. Based on a cursory viewing of television shows and movies devoted to prostitution themes, however, sex work under the guise of massage seems to be a thriving, underground industry in the United States. Even if sex work is not as commonplace as people are led to think, it is the perception of prevalence that counts. It is what forces us to be vigilant in our individual practices and as a professional group.

When I was in massage school, my fellow students and I learned to set aside our inhibitions by becoming comfortable with touch. We also learned that the way to deal with cultural misconceptions about massage therapy was by emphasizing occupational professionalism. Unlike our more privileged counterparts in medical school who could look forward to entrance into an already established profession that entertained high expectations about competence from the general public (Deierlein, 1994; Haas and Shaffir, 1995), the burden of proof was on us. Unlike the student physician who could anticipate an elite career, my fellow massage therapy students and myself learned that we were part of a larger movement that was in the process of professionalization.

Our school, like many others since the mid-1980s, was ideologically oriented toward increasing the status of the profession as a whole (Mower, 1995). Through instruction in anatomy and physiology, we were taught to embrace a medically-oriented treatment style, while still employing energetically-based techniques. Professionalism was also reinforced through the use of a dress code. Students were encouraged to join national organizations, and the negative labels “masseuse” and “masseur” were replaced with the less stigma-provoking titles of “massage therapist” and “bodyworker.” As my massage studies continued, it became clear that “stigma” was not experienced in the same way by men and women. My training in sociology should have alerted me to this possibility much earlier, but it was not until I really began talking to my colleagues that ideas for a sociological study began to take hold.

Why wasn’t more discussion of how to prevent and cope with sexually-related misunderstandings taking place, both in school and out? Why were some of the male therapists I spoke with having problems recruiting clients? What specific actions should female therapists take to protect themselves from the possibility of danger in the massage room?

After more than a year’s worth of informal discussions with therapists and students in central New Jersey, I became much more relaxed in my personal role as a massage therapist. I learned what to do to avoid potential problems, and was comforted by the fact that at least a few established practitioners felt that danger simply was not a problem.

My newly found, positive outlook, however, was shattered when I read about the assault of a massage therapist in an adjoining county. In October 1996, a female practitioner unwittingly visited the home of a male client who demanded sex. When she refused, she was severely beaten and attacked with a knife (Silvestrini, 1996). I realized that my complacency stemmed from the fact that I had not experienced anything that came even remotely close to such a horrendous ordeal. This event, however, reconfirmed that issues of stigma, sexuality, gender bias and danger were real. With my background in social research, the result for me was a more scientifically systematic probe of how therapists deal with these issues.

The Method

The analysis to follow uses exploratory, qualitative data derived from my own experiences as a student of massage/ bodywork and as a practitioner over a four-year period. Formal, hour-long, taped interviews were conducted with 15 practitioners, including one male therapist. At least 20 others talked to me on a more informal basis, including five male therapists. Their ages ranged from 20 to approximately 56 years old, and they worked in a variety of settings. Respondents were asked what led them to massage and whether or not they experienced resistance or support from spouses, partners, family and friends. They talked about the positive aspects of a daily work routine, as well as problems on the job and how they dealt with them. Because the survey sample includes only a small group of individuals available to me through informal networking, the analysis is not meant to be all-inclusive, nor are the findings meant to represent the experiences of all massage therapists and bodyworkers.


As I have sought to make sense of my data, it has become increasingly clear that the social construction of sex and gender are centrally important themes in the massage and bodywork professions.

Indeed, David Ruettiger’s commentary “No Offense...” in the Fall 1996 issue of Massage & Bodywork, illustrated how heated this subject could become. Not all of the women who wrote back in response were sympathetic to Ruettiger’s discomfort at working in a female-dominated industry in which he was often judged on the basis of his sex, rather than his character or skill level. Practically, politically and academically this debate illustrated an important point: Men and women do not experience work in the same ways. This may seem like common sense to the average person, but as far as scientific inquiries are concerned, in the past, biomedical and social research was often conducted within gender-neutral frameworks.
Biomedically, one consequence has been that since so many studies have involved male subjects only, women’s distinct health needs have been more readily ignored. Sociologically, when research on work and occupations failed to take into account sex and gender variables, this fueled a tacit assumption that differences in daily work routine, as well as outright discrimination, were either unimportant or simply did not exist. Since the 1970s, social research has begun to address the notion that masculinity and femininity are central features of most occupations. We can not truly understand how people experience work, or any other aspect of their lives, without taking into account the impact of sex and gender on individuals and entire categories of people.

Although we often hear the terms sex and gender used interchangeably, in sociology they are separate concepts. “Sex” has to do with the biological differences in genitalia, hormones, and so forth, that distinguish males from females. Sex-change operations aside, there is nothing anyone can do about their sex. It is an identity we are given at birth; one that is used as a basis for judgment when others interact with us on a daily basis. “Gender,” on the other hand, is a social construction having to do with society’s expectations about appropriate behavioral and cognitive characteristics for women and men. Unlike “sex,” we are not born with a “gender.” Gender is learned, and patterns of masculinity and femininity vary widely from culture to culture.

For example, although somewhat less rigid than in the past, in the United States, feminine roles are still often equated with attractiveness, emotionality, nurturance, deference and putting other people’s needs above one’s own. Masculinity, on the other hand, is often associated with control, ambition, strength, toughness and aggression. “Real” men don’t cry and they are successful bread-winners; “real” women look pretty and enjoy homemaking (Wood, 1994).

So how does this relate to massage? Bodyworkers of both sexes continue to grapple with many of the same issues, like how to inform the public about the health benefits of massage and how to overcome cultural norms that prohibit close physical contact between acquaintances. However, they do so in a social context within which overt and subtle assumptions pertaining to sex and gender are central. My interviews with therapists revealed that stereotyped notions about masculinity and femininity play a large role in our career development. Some of the dominant themes discussed by my respondents include issues related to negative stereotyping and homophobia for male therapists, and issues of sexual objectification and the related threat of danger for female therapists.


Regardless of one’s sexual orientation — straight or gay — men who enter professional massage/ bodywork often encounter challenges to their masculinity. This can affect them both personally and professionally, as when clients fear that men in massage are seeking to use their job to exploit clients for sexual gain. Among my respondents, the issue of homophobia was more salient for the men than the women. One male respondent reported that he had difficulties recruiting men who were willing to be worked on by him. Although he disliked being judged on the basis of his sex, he could empathize with their discomfort. He reported that one of the first times he personally had to deal with this issue was during massage school training: “I remember sciatic night. I was paired up with Jack, one of the guys in the class, and I had to work on Jack’s butt. I remember it was extremely difficult for me to touch his butt, plus do petrissage where your hands are on the whole cheek. That was extremely difficult for me to do. And I don’t think I did it... I got over it; as time went on it was a lot easier. The first time (working on another man) was difficult.”

In brief, because of the intimate nature of massage, therapists are in situations that involve crossing normally accepted physical and emotional boundaries. With Western society’s long tradition of fear and hatred of homosexuals, boundary-crossing can become a source of conflict when same-sex individuals work together. The reason that this issue might pose a greater problem for male than female therapists is that for men, massage is still considered a non-traditional occupation. Male massage therapists encounter stereotypes similar to those experienced by men in other female-dominated occupations, like elementary school teaching, hairdressing and nursing. Because they have chosen typically “feminine” occupations, they are often suspected of not meeting societal standards associated with “real” men. Some popular prejudices include suspicions that they are gay, possess potentially abusive or violent behavior, or some combination of these (Williams, 1995). For male therapists, the degree of negative stereotyping also depends, in part, on the sort of bodywork done. For example, sports massage may be considered a masculine-appropriate modality to certain clients. Thus, as one of my respondents reported, some male therapists may feel compelled to choose sports therapy as their niche, or work in a clinically-oriented setting to avoid negative reactions.

Sexual Objectification

The problems encountered by female therapists are almost the flip side of those experienced by men.

Homophobia was not mentioned as an issue that affected the women in my sample, but many did report that sexual objectification was. Although the tendency to view women in terms of their sex and/or sexuality occurs in lots of occupations, the association of massage with prostitution makes this stereotype particularly problematic for female therapists who work with male clients. Said one respondent, “The one time I felt really demoralized was early in my massage career. I was working alone in the office; everyone else had gone home for the day. I had one last client, a young man who was new. He filled out a client intake form and I explained the procedure. After leading him to the room, he pulled out a wad of bills. He didn’t say anything, but it was clear that he wanted something more than I could provide...Although nothing happened during the massage, the experience disgusted me, and I began questioning why I’d entered the field.”

Female massage therapists must continually grapple with stereotypes that might be exemplified as “good” or “bad” girl roles. To simplify, women in massage are seen as either embodying ideal notions of femininity and motherly nurturing (Madonnas) or they are whores. All of the women I spoke with reported that they had encountered these ideas at some point in their careers. Minor difficulties with the “bad” girl stigma during everyday dealings with people were discussed by many I spoke with:

“My boss, for instance, looked at me like I was from outer space when he knew I was studying this. Like, ‘What are you talking about?’ (He’s from) the old school of thought. Apparently, unfortunately, there were different things to a massage than just health and well-being. Now I think I do tend to make it clear that we learned something called medical massage, medical treatments, to avoid misunderstandings.”

“There was one busboy at work, where I was waitressing to help pay for massage school, who said, ‘Are you going to be a prostitute?’ And I said, ‘No!’ It was hard to convince him that it was a legitimate profession.”

“Sometimes when I tell people I’m a massage therapist they immediately say, ‘Ooh, massage? You can come and do me any time!’ And they are guys who think they are being funny. So I tell them right away that they can take their crap somewhere else. I am a professional.”

Other respondents talked about the sexual objectification process during sessions with clients:

“I’ve been asked to take off my clothes. A guy asked, ‘How would you feel about massaging me naked? I’ll give you an extra $100’.”

“I was massaging his stomach and he had gotten an erection and I was just like, ‘Oh, no...’ I did his legs really fast and then told him to turn over. I felt really like my intentions as a healer (were undermined). I was just some sex symbol to him. He told me my massage was mystical. I mean, come on— mystical?”

“I did a house call for somebody once. I knew as soon as I got there. He went to take a shower [before the massage], and I was a nervous wreck....When he came out I didn’t even have the table open. He was like, ‘Is something wrong?’ I said, ‘I’m having a really uncomfortable feeling. Maybe it’s just me, but I’m leaving now.’ He was standing in front of my table so I couldn’t get to it. I felt like I was being threatened.”

In sum, the stereotypes these female respondents dealt with ranged from the misunderstandings of the ill-informed (the most commonly reported), to more significant and threatening encounters during work. None of the respondents had ever been assaulted, but they had experienced circumstances that felt dangerous on physical and/or emotional levels.


As bodyworkers in an emerging profession, all practitioners are affected in some way by negative stereotyping and/or threats of danger in the massage room. What is more, the experiences of female and male therapists often do overlap, even on the issues discussed above. For example, several respondents reported having heard of instances involving male or female clients who made sexual advances toward male therapists in the massage room. What I have focussed on in this discussion are the most frequently-occurring circumstances. Generally speaking, the male therapist’s practice is more likely to be limited when male clients fear that bodywork by a man is an indication of homosexuality or when female clients fear that bodywork by a man is potentially dangerous and/or crosses a boundary that they are uncomfortable with. Although negative stereotyping may limit the practices of male therapists in a numerical sense, danger and sexual devaluation are not as problematic as they are for female therapists. Women may seem to be preferred by clients, but client preferences can sometimes put women at risk physically and/or emotionally.

So, what’s positive here? As far as men’s and women’s social roles are concerned, I believe that the massage profession offers enormous possibilities. Perhaps I am naively optimistic, but by challenging rigid cultural ideas about feminine, masculine and sexual roles, massage therapists of both sexes are true cultural pioneers. Although much has changed in the past 20 years, feminine qualities are still very often devalued in the workplace. This makes it difficult for women to enhance their economic prospects within occupations. In part because of the high value placed on nurturing, women in this field are experiencing success, and this is a positive thing. Female massage therapists are also challenging popular stereotypes by demonstrating that, like their male counterparts, they can do physically demanding work. How often are clients, especially male clients, surprised that “such a little girl” can work so deeply?

Men who enter massage are also trailblazers. Their participation in a care-providing occupation demonstrates they are capable of nurturing and that intimate contact does not necessarily need to involve sex or violence. Although perhaps not intending to, male bodyworkers help to re-fashion widespread ideas about what it means to be masculine. In the ongoing struggle to end rigid gender role limitations, this too is heartening.