Below is a comprehensive, medically grounded article exploring two very different motivations for genital surgery involving penis size:

1. Men seeking penile enlargement (augmentation)
    
2. Men seeking the smallest possible penis size or removal (reduction, nullification, or related procedures)
    

This is presented from both psychological and medical perspectives, with attention to risks, outcomes, ethics, and lived motivations.

In modern medicine, genital surgery involving penis size sits at a complicated intersection of cosmetic surgery, urology, gender identity, and psychology. While some men seek to increase size for confidence or sexual identity, others seek to minimize or remove the penis entirely for reasons tied to gender expression, dysphoria, or fetish identity.

Understanding both sides requires looking at the procedures themselves, the medical risks, and the human motivations behind them.

For many men, the desire for a larger penis is rooted in body image and cultural expectations. Some experience what clinicians call penile dysmorphic disorder, where men with normal anatomy feel inadequate due to social pressure or unrealistic comparisons. 

Common motivations include:

• Desire for greater sexual confidence
   
• Anxiety about masculinity or attractiveness
   
• Comparison to pornographic standards
   
• Belief that size affects performance or partner satisfaction
   

Importantly, most men seeking enlargement already have normal anatomy, and surgery is rarely medically necessary. 

Modern enlargement surgery includes several techniques:

• Cuts the ligament anchoring the penis to the pubic bone
   
• Allows more of the shaft to hang outward (appears longer flaccid)
   

• Fat or materials injected to increase girth
   
• May increase size modestly but can reabsorb or deform over time
   

• Subcutaneous implants inserted to create thickness
   
• Can change appearance but carry implant-related risks
   

• Non-permanent filler-based girth enhancement
   
• Some studies show moderate girth increase and satisfaction
   

The reality is modest:

• Some procedures may slightly increase girth
   
• Some create the appearance of length in a non-erect state
   
• Most do not significantly increase erect length
   

Because expectations are often unrealistic, dissatisfaction rates can be significant.

Penile enlargement surgery is medically controversial due to a relatively high complication profile.

Common risks include:

• Infection
   
• Scarring and deformity
   
• Loss of sensation
   
• Erectile dysfunction
   
• Pain or chronic discomfort
   
• Dissatisfaction or need for revision surgery
   

More severe complications documented in studies include:

• Tissue necrosis (tissue death)
   
• Chronic inflammation or granulomas
   
• Implant erosion or migration
   

Some reviews warn that complications can lead to permanent functional damage and deformity even in men who started with normal anatomy. 

Some men report:

• Increased self-confidence
   
• Improved body image
   

But others report:

• Continued dissatisfaction
   
• Anxiety or regret
   
• Psychological distress if complications occur
   

Because of this, many urologists recommend psychological counseling before surgery.

At the opposite end of the spectrum are individuals who seek to reduce or eliminate the penis.

This group includes:

• Transgender or nonbinary individuals
   
• People with gender dysphoria
   
• Men pursuing feminization or nullification
   
• Individuals with specific identity or fetish motivations
   

Less common, but may involve reducing length or reshaping tissue.

Removal of part or all of the penis, usually done medically for cancer but also sometimes chosen in gender or identity contexts.

Removal of penis and sometimes testicles to create a smooth or neutral genital appearance.

Often part of gender-affirming or identity-based procedures.

For trans feminine individuals, this may involve:

• Penile inversion vaginoplasty
   
• Creation of a vulva using penile tissue
   

These procedures can transform anatomy and identity.

Motivations can include:

• A person may feel their penis is inconsistent with their gender identity
   
• Removal or transformation may relieve dysphoria and improve mental health
   

• Desire for a smoother, less masculine body
   
• Alignment with feminine or nonbinary expression
   

• Some individuals eroticize smallness, absence, or “loss of masculinity”
   
• Others associate removal with submission or transformation
   

One of the most complex genital surgeries is phalloplasty (construction of a penis) or its inverse procedures used in gender affirmation contexts.

Genital reconstructive surgery is major and multi-stage, with:

• Months to years of recovery
   
• Possible complications like infection, urinary problems, or tissue necrosis
   

Penectomy and nullification procedures also carry risks including:

• Infection
   
• Bleeding
   
• Urinary complications
   
• Hormonal changes
   
• Permanent loss of sexual function
   

In extreme cases historically, emasculation can lead to long-term physiological changes such as fat redistribution and loss of body hair. 

Many individuals report:

• Relief from dysphoria
   
• Alignment with identity
   
• Improved mental well-being
   

However, potential risks include:

• Regret if decisions were not carefully considered
   
• Loss of sexual function or sensation
   
• Social stigma
   

Because of this, gender-related surgeries typically require mental health evaluation and informed consent protocols.

AspectEnlargement SeekersReduction/Removal SeekersCore motivationIncrease masculinity/confidenceReduce masculinity or align identityMedical necessityRarely medically requiredOften tied to gender dysphoriaTypical resultModest size increaseSignificant anatomical changeRisk levelModerate to highHigh (major reconstructive surgery)Psychological outcomeMixed satisfactionOften positive when aligned with identity  

Across both groups, doctors emphasize:

Patients must understand permanent consequences and risks.

Especially when motivations are driven by body image or identity.

Both enlargement and reduction surgeries can produce unexpected outcomes.

Body image concerns often require holistic treatment.

Small penis surgery exists on a spectrum of human experience:

• On one end, men seek more size to feel more masculine
   
• On the other, individuals seek less or none to feel more authentic
   

Both paths reflect deeply personal relationships between body, identity, sexuality, and self-image.

But medically, both come with real risks, limitations, and life-changing consequences—which is why modern healthcare approaches these decisions with caution, psychological screening, and long-term support.