I can't say that I fully know, but here goes (my personal thoughts, not some "philosophy):
1. My bdsm and medfetish sessions have always been enema driven or at least involved. I've personally enjoyed them since my early teens, love the sense of penetration and fiiling, the inexorability of the water entering, forcing it's way into me until I must get relief. Give to myself mostly, but love to receive from a woman when there is opportunity.
2. I always wanted to give. That urge was a precursor to sex, often anal sex, but given the choice, I often picked giving a girl an enema series over having sex or getting a blowjob. I love the control, making her take it, inserting the nozzle into her bottom (or colon tube, or plug/nozzle, or, and especially, the inflatable nozzle. I am very much into volume in giving, especially if there is lots of moaning and begging, but I never push it so as to cause harm. I love the idea of training my sub to take 4 quarts, but two is much more realistic. So I would say I am a straight Dom klismophile, with a love for anal and rectal stimulation.
3. My favorite scenario is to receive multiple large enemas and prostate massages from my girl, then to give her "enemas till clear," as much as she can take, and after she's empty & enough time has passed so she's no longer sore, vaginal & anal sex with her.
Additional thoughts: while I fantasize about enemas a lot, I don't consider children a target, not even those in my family. I am utterly opposed to pedophilia, even though I had a number of sexual experiences on my own from fairly early on, and I knew I was anal erotic from my early teen years. I always fantasized about giving girls enemas, from the 7th grade on, because to me that was one of the height (depths?) Of my sexuality. I got my chance with my first gf, when I was 16. I never had the courage to make mutual enemas a part of our sexplay, and that may have been due to the fact that I also instinctively knew I wanted her under my control. At the time I had no theoretical understanding of BDSM, but I was certainly aware of its practical applications, though I couldn't name it. I broke up with my first gf, and I have always regretted it.