It is very common for men to get an erection during a non-sexual, therapeutic, full body massage. While an erection can be indicative of being physiologically aroused, it does not necessarily indicate the presence of emotional or sexual desire. Touch administered to any part of the body can activate the parasympathetic nervous system, which can result in a partial or complete erection. Professional assessment can help a therapist decipher a physiological response to touch from inappropriate sexual intentions.

While physical arousal can occur with both male and female clients, a woman’s arousal is typically less visible. Fear of an erection, or a massage practitioner’s response to it, prohibits some men from seeking a much needed therapeutic massage. For those devoid of inappropriate intentions, education about normal body function can ease this fear and invite a new level of comfort with 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.

  • Discomfort on the part of the client or the therapist will divert the focus of the therapy, resulting in decreased effectiveness.
  • If a man shows no signs of embarrassment or discomfort due to his erection, and the therapist is comfortable, then addressing it is not necessary.
  • 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.
  • Because the antidote to a parasympathetic response is activation of the sympathetic nervous system, changing the technique being used can quell a spontaneous erection.
  • 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.

Based on fundamental communication skills, Ben E. Benjamin, Ph.D. and Cherie Sohnen-Moe describe “The Intervention Model” in The Ethics of Touch. When a client’s intent is unclear, The Intervention Model contains eight steps to guide a practitioner’s assessment and subsequent action in response to ethical dilemmas. Dependent upon the details of the situation being addressed, it may be necessary to consecutively progress from step one to step eight, stop after step one or two, follow the steps in a different order, or skip inapplicable steps altogether. The following outline of The Intervention Model has been slightly modified for approaching a client with an erection when the client’s intent is not understood.

Step One: Stop the treatment using assertive behavior.

  • Addressing the client with body language congruent with verbal communication demonstrates assertive behavior.
  • Tips to remain assertive include making eye contact, standing with relaxed, yet grounded posture, and using a firm voice.
  • Shrinking or speaking quietly portrays passivity, while yelling or touching inappropriately displays aggression. Avoid both.
  • By adjusting the drape to make sure the client is properly covered, the therapist non-verbally confirms professional boundaries. Additionally, if touch has contributed to a sexually aroused state, adjusting the drape physically stops the cause of stimulation.
  • At this point, maintaining safety is crucial. If the therapist feels intimidated, repositioning with easy access to an exit can allow for safety should the client become actively threatening.

Step Two: Describe the behavior.

When encountered with an erection, stating the obvious can be difficult, but clarifies the client’s intent. By describing a behavior, the client knows the therapist is paying attention without passing judgment. Examples of this type of communication are:

  • “I notice you’re tightening your muscle and grimacing when I pass over this area.”
  • “I am aware that you made a comment about my appearance, then made a sexual joke, and now you have an erection.”

Step Three: Clarify the client’s intent.

After stating the obvious, directly asking the client what they are experiencing can reveal the meaning behind the erection. Examples include:

  • “Can you tell me what’s happening?”
  • “What are you experiencing?”

Dependent upon the client’s comfort level and their intent, a client’s response 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 for the practitioner to render an accurate assessment.

Step Four: Educate the client.

During a somatic-based therapy, some recipients experience unexpected emotional and physiological responses. When aware of a client’s concerns, the therapist can share information to educate the client. Examples of educative statements for a client experiencing an unintentional erection are:

  • “Sometimes clients become aroused as a physiological response to touch. It is a normal body response.”
  • “It’s natural for some men to have a physical response to massage.”
  • “I noticed you had an erection during the last massage. I want you to know that erections are usually just a physiological response to touch and it’s not unusual for clients to have them.”

Step Five: Re-state your intent.

Safety is re-established by a therapist clarifying the therapeutic contract of the session. Examples of re-instating therapeutic intent are:

  • “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.”
  • “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 with sexual intent or displaying inappropriate behavior necessitates immediate termination of a session.

  • If sexual intent is determined right away, there is no need to employ the previous steps.
  • If a client’s intent remains unclear, establishing conditions may be necessary.
  • An example of establishing conditions is “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.

This step is typically taken after the completion of a session.

  • In your opinion, if your client could benefit by professional help from a psychotherapist, counselor, or other medical practitioner, provide referral information to the client when he is fully dressed and alert.

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 evoke ethical questions and safety concerns. Seeking supervision indicates a commitment to ethics and professionalism.
  • 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, be sure to include all the facts, including your own actions. This is vital should a client ever lodge a complaint.

Encountering the male physiological response to parasympathetic arousal is a frequent occurrence in the massage profession. Professionally managing human interaction surrounding this type of arousal requires preparedness, maturity and education. Determining the intention behind a man’s erection serves to maintain professionalism, ensures therapist safety, and reduces client embarrassment. Meanwhile, communication regarding client behavior, therapeutic intent and the physiological normalcy of erections allows a therapist to preserve ethical boundaries while maintaining respect for the client.

Resources:

Benjamin, Ben E., Ph.D., and Cherie Sohnen-Moe. The Ethics of Touch. Tucson: Sohnen-Moe Associates, 2003.

McIntosh, Nina. The Educated Heart Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers. 2nd ed. New York: Lippincott Williams & Wilkins, 2005.