The psychogenic component in common gynecologic disorders such as pelvic pain, the amenorrheas, and chronic vaginitis often takes the form of a depressive or anxiety reaction which can be identified by health care providers without psychiatric training. Such an identification enables the provider to understand otherwise unintelligible aspects of the patient's response to medical or surgical treatment and to make appropriate referrals for psychiatric evaluation and/or treatment. However, serious psychopathology that is atypical and less easily identified can also find expression in gynecologic complaints. This paper presents a report of such a case and concludes with suggestions for recognizing the presence of significant psychopathology in patients with uncommon expressions of underlying anxiety.