“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.