The preservation of mahramiyyah (permissibility) in medical examinations has always been a challenging issue from the perspective of fiqh (Islamic jurisprudence). This matter becomes particularly significant in cases where medical necessities conflict with religious rulings. This analytical-research study, with a comparative approach, was conducted to provide a new framework to establish a balance between medical necessities and fiqh rulings. First, the theoretical foundations and research background were first extracted using reliable library sources, fiqh texts, and scholarly medical books and articles. Sources were searched in the following databases: PubMed, Scopus, Web of Science, Scientific Information Database (SID), Magiran, NoorMags, the Computer Research Center of Islamic Sciences (Noor), and the Comprehensive Jurisprudence Database. The keywords used included “Medical Mahramiyyah,” “Medical Fiqh,” “Medical Necessity,” “Non-Same-Sex Examination,” “Patient Privacy,” “Islamic Telemedicine,” and “Medical Religious Rulings” in Persian, English, and Arabic. Selected sources spanning the period during 1981-2024 were evaluated. The inclusion criteria comprised direct relevance to the topic, peer review, and appropriate content quality. The exclusion criteria included irrelevance to the topic, non-peer reviewed, replicate sources, studies with low quality or without valid data, public or news reports lacking scientific basis. Ultimately, 37 sources were selected and analyzed based on thematic analysis and fiqh deductive reasoning to identify common principles and points of conflict between the fiqh data and medical requirements. Emerging challenges in medical fields, such as telemedicine, were also evaluated. Although the primary principle in Shia fiqh is the prohibition of looking at (except for the face and hands up to the wrist) and touching a person of the opposite sex, whether for treatment or otherwise, there is a consensus among faqihs (Islamic jurists) that, in cases of necessity, this principle is suspended. As a result, examinations requiring touching and looking, even of the genitals, by a physician of the opposite sex are permissible. In both fiqh and medicine, necessity is defined as an urgent need for treatment or medical procedures that, if not performed, could lead to a serious threat to the patient's health. However, some faqihs, based on the rational rule of “Irtikāb Aqall al-Qabīḥayn” (committing the lesser of the two detestable things), deem direct touch and direct viewing to fall under the primary prohibition in instances where telemedicine and indirect examinations suffice for the aforementioned necessity. This research offers practical solutions to maximize the preservation of mahramiyyah in medical examinations, aiming to improve the quality of medical services in Islamic societies while adhering to religious principles.