We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P=NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P < 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P < 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P < 0.005), and abnormal menses (P < 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P < 0.05), and IBS was present more often when pain was a reason for hysterectomy (P < 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P < 0.01) and lower pain improvement ratings (P < 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non- IBS patients (P < 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.