Background <p>Postoperative pain is a persistent challenge in gynecological surgery, influenced by psychological and clinical factors. Surgical anxiety, a critical preoperative psychological state, is shaped by underlying psychological conditions that can affect pain experiences during recovery. This study aimed to explore the psychological factors contributing to surgical anxiety and their interaction with postoperative pain outcomes, focusing on anxiety, psychological distress, and general gynecological status.</p> Methods <p>A cross-sectional study was conducted with 114 women undergoing gynecological surgery at a tertiary care hospital. Data collection included demographic and clinical characteristics, along with psychological assessments using the surgical anxiety questionnaire, Kessler psychological distress scale, and general health questionnaire-12. Postoperative pain was evaluated using the American Pain Society Patient Outcome Questionnaire-Revised and the Postoperative Pain Assessment Tool-Day 1/7. Statistical analyses involved correlation tests, group comparisons, and structural equation modeling (SEM).</p> Results <p>Psychological distress and general health were significant predictors of surgical anxiety. Higher levels of surgical anxiety were associated with increased psychosocial impacts on postoperative pain, particularly in activity interference and self-care. SEM analysis revealed moderate indirect effects of surgical anxiety on pain outcomes through psychological distress, while direct effects on pain were minimal.</p> Conclusions <p>Preoperative assessments of psychological distress and general health are essential for understanding surgical anxiety and its nuanced impact on postoperative pain. Tailored pain management strategies that address both psychological and clinical factors may enhance recovery and patient satisfaction following gynecological surgery.</p>