I always go completely nude under the covers during my massage therapy appointments for my lower back issues. Recently I asked a few friends and all of them wear underwear… does my massage therapist think I’m a creep? Before talking with them, I always thought everyone stripped down completely.
As a massage therapist I can tell you that wherever I work the long time clients all go with out underwear as honestly is the norm. Athletes as well. It is very difficult to work the back with bra straps in the way or getting into the glutes and IT band with elastic bands in the way. And the oil gets everywhere. There is really no sense to come in with underwear on. Your bottom is always covered with a blanket. That is the rule for therapists. It benefits both sides to just take them off
I mean, do whatever is comfortable for you, but do you really think that it de-sexualizes the situation to make your massage therapist play with your waistband and possibly have to pull down your shorts herself during the massage?
As a physician, I'll always ask a patient to remove or manipulate their clothing themselves if they are able rather than doing so myself when "sensitive areas" need to be accessed. It would feel way more invasive to yoink someone's underwear down myself than to just have them undress before I begin the exam. To me, the act of manipulating someone's clothing only increases the awkwardness and the odds of sexual intent being perceived by one party or the other.