The authors conducted a cross-sectional study of 895 never-smoking female textile workers, aged 20-40 years, employed in three cotton textile mills in Anhui Province, China, to assess the association of self-reported occupational stress with dysmenorrhea. Stress was assessed by means of a questionnaire incorporated into a larger, general health survey of textile workers. Dysmenorrhea was defined as abdominal/pelvic pain during menses. Proportions of no/low, moderate, and high levels of occupationally-related emotional stress among all the subjects were 56%, 23%, and 21%, respectively. The overall prevalence of dysmenorrhea in the population was 59.7%. The adjusted odds ratios of dysmenorrhea for women who had moderate and high levels of occupational stress relative to those with low levels were 1.6 (95% CI:1.1-2.2) and 2.3 (95% CI:1.6-3.4), suggesting an exposure-response relationship. The estimated odds ratio based on assigned scores (0, 1, and 2 assigned for no/low, moderate, and high degrees of occupational stress) was 1.5 (95% CI:1.3-1.8). In the analyses stratified by the mills and the women's job titles, a positive association was found in all groups. The association remained significant (OR = 1.6, 95% CI:1.3-2.0) when the analysis was restricted to those women with only one reported livebirth pregnancy. The findings suggest that high degrees of occupational stress predispose female textile workers to dysmenorrhea.