This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about identity construction of men who pay women for sex (MPWS). A corpus of 54 qualitative studies about the experiences and perceptions of MPWS was synthesized, using the theoretical framework of symbolic interaction and QMS guidelines. This synthesis yielded novel insights into the meanings that MPWS attribute to their involvement in the sex industry, within a range of interpersonal interactions and social discourses. We identified and expanded on six social discourses that affect the identity construction of MPWS: sexuality; intimacy; consumerism; power; deviancy and normativity; and masculinity. The findings demonstrate that paying for sex (and in particular, the stigma associated with it) permeates many life spheres of MPWS, and affects their gendered, sexual, cultural, intimate, consumerist and social identities, and self-perceptions. The discussion centers on four major understandings derived from the QMS: paying for sex is central to the lives of MPWS; paying for sex generates conflict in the identities of MPWS; discourses of masculinity are prominent in the identity construction processes of MPWS; and the literature on MPWS needs further social and cultural contextualization. These understandings have profound implications for sex-industry-related policy and social interventions.