This study evaluates the distress experienced by women attending gynecology outpatient clinics (GOCs). We investigate causes of this distress and explore women's own experience of their distress. A questionnaire survey of 197 women attending GOCs was carried out, both quantitative and qualitative analyses were undertaken. Thirty-five percent of women showed clinical levels of anxiety, 13% had clinically significant depression and half reported feeling distressed. A range of feelings was reported, though commonly mixed emotions were expressed. Women had a low sense of personal control and uncertainty in relation to their gynecologic problem. Both coincidental stress, such as life changes, and the direct consequences of the gynecologic problem were predictive of anxiety. Qualitative analysis suggested four ways in which women experienced their distress and the gynecologic problem: (i) gynecologic symptoms were a direct cause of distress, (ii) gynecologic symptoms caused distress indirectly through reactions to diagnosis and treatment, (iii) gynecologic symptoms caused distress because of their impact on relationships, social life and self identity, and (iv) distress was unrelated to the gynecologic symptoms. Results highlight diversity and complexity in women's experiences and support the need for a fuller understanding of distress in this group in order to meet their needs adequately and appropriately.