Forty women with pelvic pain were investigated by means of psychiatric interviews and psychological tests. A group of 25 pregnant women served as controls. Psychiatric disturbances were more frequent and more severe in the study group than in the control group. This was shown in their over-all adjustment as well as in the number of their neurotic, psychotic, and psychosomatic symptoms.Although all patients with pelvic pain (with 2 exceptions) were married, they were highly ambivalent toward their husbands as well as toward homemaking per se and were in active conflict over their role in life, while patients in the control group were more accepting or, in some instances, more resigned. This issue was underscored when the sexual, menstrual, and gestational performances of the two groups were compared. In all of these activities the incidence of disturbances was significantly higher for the group with pelvic pain.We were only rarely successful in tracing the development of pain in a patient's life history to its origins. If painful early memories were more frequent among the patients with pelvic pain than among the controls, the difference is not statistically significant.It was postulated that patients with pelvic pain were unable to establish and preserve that (unconscious) sense of feminine identity which permits the unhampered exccution of feminine functions (homemaking, relating affectionately to a husband, performing sexually, menstrually, and gestationally).It was inferred that early severe anxieties about female functions had been subjected to massive repression, denial, and projection and that both phobic avoidance and countermagical maneuvers were employed in relation to men. This made it possible to enter marriage and to satisfy unconscious dependency and Oedipal needs. When in the course of marriage a steady demand upon the exercising of female functions was made, customary defenses failed, and pelvic pain, with or without chronic pelvic congestion, developed. The tentative conclusion was drawn that pain experiences which had played an important part in the early life of our patients were regressively revived and were woven into the conflicts surrounding adult femininity.Figure Drawings, Thematic Apperception Tests, and Rorschach Tests were administered to the majority of the patients in the study. In those tests, the patients with pelvic pain gave further evidence of an unusual degree of anxiety concerning feminine functions. Repression, denial, and projection were used so pathologically that the image of the sexes was often quite distorted, especially the image of the male. The psychological tests helped to document some of the clinical findings and impressions and were instrumental in the formulation of the feminine identity problems displayed by our patients. XII. Anatomical responsesGroup with pelvic painPrenatal groupSexual187Nonsexual127Total3014