Background: Immune checkpoint inhibitors (ICIs) have transformed gynecologic cancer treatment, but their use is complicated by immune-related adverse events (irAEs) that pose significant clinical challenges. Objective: This review systematically summarizes the epidemiology, mechanisms, recognition, and management of irAEs in gynecologic malignancies, highlighting controversies and future directions. Main content: IrAEs occur in a substantial proportion of gynecologic oncology patients, with varying onset and severity profiles by ICI class and cancer type. Pathophysiological mechanisms include off-target T-cell activation and molecular mimicry. Recognition requires vigilance toward multi-organ toxicities. Management follows CTCAE-guided tiered strategies: mild events permit continued immunotherapy with supportive care, while severe toxicities require treatment interruption and corticosteroids, with escalation to second-line agents in refractory cases. Special considerations include combination regimens, elderly patients, and immunotherapy rechallenge decisions. Conclusion: Optimal irAE management requires multidisciplinary collaboration, individualized risk assessment, and standardized protocols. Future research should focus on predictive biomarkers and preventive strategies to maximize efficacy while ensuring safety.