This is widespread in cool temperate regions of North America. The species is widely recorded from wooded regions of Ky., mostly on medium acid soils. However, numbers of plants at each site are often small and many records are old. The only confirmed records from the Bluegrass region (excluding transitions to the Knobs) are: a coll. by J.S. Foote in 1967 from FRAN (KY) on "flood plain of Elkhorn River opposite cliffs above Frankfort"; an 1840s coll. by T. Lea from KENT (PH); and a coll. from the Blue Licks area of ROBE (APSC) by C. & J. Baskin in 1987. It seems likely that much digging of this showy species has occurred for short-term ornamental or herbal uses, as also noted by Gm in 1914: "Neither plant [see parviflorum] is now common in Kentucky, probably a result of the persistent search for them by collectors of herbs." The genus Cypripedium, globally, has suffered from excessive collection (Cribb & Sandison 1998); C. calceolus has been almost eradicated from Britain (Kull 1999). There is little definitive information about medicinal effects, but pubescens was apparently much used by Native Americans and then marketed by settlers. Rafinesque (1828) summarized uses of Cypripedium species at that time: "They are sedative, nervine, antispasmodic, and the best American substitute for Valerian in almost all cases. They produce beneficial effects in all nervous diseases, and hysterical affections, by allaying pain, quieting the nerves and promoting sleep. They are also used in hemicrania, epilepsy, tremors, nervous fevers. They are preferable to Opium in many cases, having no baneful nor narcotic effects, The dose is a tea spoont\il of the powder, diluted in sugar water, or any other convenient form." Gm (1914) merely noted: "Its root stocks are collected for the manufacture of a medicine, considered useful in nervous disorders." MacDougal (1895) and others (as reviewed by Gm) also reported that glandular hairs of pubescens cause skin irritation in some people (but not others); the irritant action increased with development of the plant, and a maximum effect was reached during formation of seed capsule. The active compound appears to be "cypripedin", which also occurs in some other orchids; this is now known to be a phenanthrene-quinone derivative that may have varied potential therapeutic uses (Bartsch et al. 1986, Wattanathamsan et al. 2018).