Objectives This qualitative study investigates the complex interplay of social, cultural, and professional dynamics influencing women’s decisions to undergo Female Genital Cosmetic Surgery (FGCS) in Mashhad, Iran. The research aims to explore how reference groups—including physicians, prior patients, and media representations—shape perceptions and decisions regarding FGCS within the broader context of shifting gender norms and esthetic expectations in Iranian society. Methods The study employed a qualitative design using in-depth, semi-structured interviews with 26 women aged 18 to 46 who had undergone or considered FGCS. Data were analyzed through Colaizzi’s phenomenological method to capture the lived experiences and meaning structures of participants. The thematic analysis identified recurring patterns related to social influences, medical authority, marketing strategies, and ethical concerns within private clinical settings. Results Several pivotal themes emerged from the analysis. Physicians held significant influence as authoritative reference points, often guiding patients’ esthetic ideals while engaging in unethical practices within private clinics. Financial facilitation mechanisms—including discounts, installment plans, and tax evasion—were frequently employed to encourage surgical uptake. Additionally, the persuasive role of social media, online influencers, and patient promoters contributed to normalizing FGCS as a socially acceptable intervention. The study also revealed a troubling absence of regulatory oversight in private clinics, exacerbating malpractice risks and ethical violations. Conclusions The findings underscore the convergence of professional authority, cultural narratives, and commercial interests in shaping women’s intimate bodily decisions in contemporary Iran. FGCS is situated within a complex matrix of bodily autonomy, religious morality, esthetic aspiration, and social mobility. The study highlights the urgent need for public education on natural genital diversity, stricter ethical guidelines for medical professionals, and comprehensive policy reforms to safeguard patient rights and ensure informed, consensual, and ethical cosmetic practices.

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