ArticleSexual medicine2026
"Not enough" vs. "never perfect": a qualitative analysis of penile enlargement surgery intentions in heterosexual and homosexual men.
Article in Sexual medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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