Background <p>This study aimed to explore female sex workers’ experiences of the COVID-19 pandemic in Iran, with a particular focus on economic hardship, changes in client relationships, access to COVID-19–related and general health services, misinformation and prevention practices, and intersecting structural vulnerabilities.</p> Methods <p>A qualitative Narrative Inquiry approach was used to explore the lived experiences of female sex workers referred to Drop-In Centers (DICs). Purposive sampling complemented by snowball recruitment identified 21 participants. Semi-structured interviews were conducted, and data were analyzed using Narrative Thematic Analysis consistent with Riessman’s methodological principles.</p> Results <p>Pandemic-related economic shocks reduced income and bargaining power; misinformation fueled both denial and fear of COVID-19; disruptions in client relationships increased exposure to violence; and barriers to health care led many women to delay treatment or rely on self-medication. These challenges were compounded by criminalization, lack of identification documents, substance use, and caregiving responsibilities.</p> Conclusions <p>The COVID-19 pandemic amplified pre-existing vulnerabilities among female sex workers in Iran. Participants experienced severe income loss, reduced negotiating power with clients, increased exposure to violence, widespread misinformation, and major barriers to COVID-19–related and general health services, particularly among women lacking identification documents and those with caregiving responsibilities. Low-threshold, crisis-responsive interventions delivered through Drop-In Centers and outreach teams are needed to mitigate harms during future public health emergencies.</p>