<p>The intentional alteration of the labia minora, known as labiaplasty, has shown increased prevalence across various populations in recent decades. While aesthetic, sexual, and psychological factors predominantly drive the desire for labiaplasty, there remain numerous unknown elements which influence a woman’s decision-making processes regarding this procedure. This study was undertaken to understand why Iranian women choose labiaplasty, examining the various motivations, influences, and considerations shaping their decision-making process. Semi-structured in-depth interviews were completed with 14 Iranian women who were seeking labiaplasty. The women were asked about their familiarity with labiaplasty, the motivations for undergoing the surgery, the sociocultural factors influencing their decisions, the process of seeking surgical intervention, their discussions with medical practitioners about concerns regarding their labia, and the reactions from their social circle about their decision to undergo surgery. The interviews were audio recorded, transcribed verbatim, and analyzed using a content analysis. Three overarching clusters were derived from the analyses: (1) “Motivations” which included aesthetic concerns, physical or sexual discomfort; (2) “Influences”—a theme emerging from women’s narratives, encompassing factors such as facilitating beliefs, alongside the reported impact of health professionals, media, and social circle on their decision-making processes; and (3) “Navigating Stigma” which highlighted the stigma and sexual taboos which women identified as being linked to their experiences with choosing labiaplasty. The convergence of diverse personal and social dynamics plays a crucial role in shaping women’s decisions, leading them to seek labiaplasty. Consequently, preoperative psychological counseling appears to align more closely with the implementation of ethical principles, ensuring women make informed choices about their surgical options.</p>