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Generally you are nude during the massage, but always covered with sheets. When it's time to turn over, the therapist holds up the sheet and looks away so you're covered as you turn over.
You can wear underwear if you're uncomfortable with complete nudity, but this means the therapist can't work the large muscles of the gluteus maximus and hip attachments, which are often problem areas.
Spas may request you wear a swimsuit or disposable briefs during hydrotherapy treatments.
(This is especially true with men.) Women are often allowed to choose, but you have to be comfortable with the idea that the therapist will see everything at some point.
You can find a more relaxed attitude towards nudity at some hot springs or mineral springs spas with co-ed tubs, like Ten Thousand Waves in Santa Fe, N. Even the Palm Springs, California clothing-optional resort Sea Mountain uses draping during massage at its spa.
European spas are considerably more relaxed about nudity, both in the treatment room and in co-ed Sauna Worlds.
The answer is "no," at least in the United States and at most resort spas and destination spas in Canada, Mexico, and the Caribbean. Only the part of the body that is being worked on is exposed.
Another concern is a fear of one's body being judged.It is quite different from the vibe in American spas, where even sitting in a co-ed lounge with a man can be uncomfortable for some.First you generally change into a robe and slippers in the women or men's locker rooms.And it can be an intense experience, even for experienced spa-goers. Think twice about getting a body treatment like a salt glow or a Vichy shower if you're uncomfortable with spa nudity. Most spas offer disposable panties for the body treatment.Sometimes they're optional, and sometimes the spa requests you wear them.Some day spas and chains like Massage Envy don't have locker rooms, so you take your clothes off in the treatment room and slip under the sheet.