"Not enough" vs. "never perfect": a qualitative analysis of penile enlargement surgery intentions in heterosexual and homosexual men.

BACKGROUND

Psychological motivations for penile enlargement surgery (PES) remain understudied, particularly across different sexual orientations.

AIM: This study explores the psychosocial drivers of PES intentions among heterosexual and homosexual cisgender men.

METHODS

Twenty-four cisgender men (12 heterosexual, 12 homosexual) who had undergone or recently consulted for PES were interviewed using semi-structured protocols. Data were analyzed via thematic analysis, guided by the Push-Pull Theoretical Model. Push factors refer to internal pressures that motivate individuals to seek PES, while pull factors involve external influences.

OUTCOMES: Distinct motivational pathways toward PES were identified based on sexual orientation.

RESULTS

Two shared pull factors, physiological safety concerns and social exposure risks, were evident across groups. However, push factors varied: heterosexual men emphasized partner-driven pressures such as sexual performance anxiety, masculine adequacy concerns, and partner-related comparison. Homosexual men highlighted community-driven influences, including body image anxiety, perfectionistic enhancement culture, and peer-based comparison norms. These findings reveal two diverging logics: relational adequacy versus visual optimization.

CLINICAL TRANSLATION: Tailored psychological screening and counseling strategies should consider the influence of sexual orientation and underlying motivational logic.

STRENGTHS AND LIMITATIONS: This study addresses a gap in male body image and LGBTQ+ surgical intention literature. Limitations include a modest, urban-leaning sample and a focus on intention rather than postoperative outcomes.

CONCLUSION

Sexual orientation significantly shapes men's motivations for PES, with heterosexual men driven by partner-related anxiety and homosexual men influenced by community-based ideals. Understanding these distinctions is critical for ethical and effective clinical intervention.