Background <p>Reproductive concerns (RCs) have emerged as a prominent psychosocial issue among women with gynecological cancer who undergo fertility-sparing surgery (FSS). However, the ways in which RCs relate to health-related quality of life (HRQoL) and are experienced within broader social and cultural contexts remain insufficiently understood.</p> Methods <p>In the quantitative phase, 122 women who had undergone FSS for gynecological malignancies completed questionnaires assessing RCs, body image and sexual adjustment, social support, and HRQoL. Descriptive statistics, correlation analyses, and hierarchical multiple linear regression were performed. Quantitative findings informed purposive sampling and the development of the interview guide for the qualitative phase. Semi-structured interviews were conducted with 10 participants and analyzed using thematic analysis until data saturation was reached.</p> Results <p>Higher levels of RCs were significantly associated with poorer HRQoL. Body image and sexual adjustment were also significant predictors of HRQoL, whereas social support was not independently associated with HRQoL in the final regression model. Qualitative analysis generated three overarching themes: (1) the individual body: embodied challenges and identity transformation; (2) the social body: negotiating relationships and societal expectations; and (3) the body politic: medical authority and reproductive decision-making.</p> Conclusion <p>RCs were closely associated with HRQoL among women following FSS for gynecological cancer. Qualitative findings suggest that RCs extend beyond individual psychological distress and are embedded within relational, medical, and sociocultural contexts. Clinical care should incorporate attention to body image and sexual adjustment while recognizing the relational and sociocultural pressures surrounding fertility that influence women’s HRQoL.</p>