Q-tip Test

Original Editor - Khloud Shreif

Top Contributors - Khloud Shreif and Kim Jackson  

Introduction[edit | edit source]

Q- tip test or cotton swab test was described for the first time by Crystle et al in 1971. It is a simple, non-expensive clinical test used to assess urethral mobility, vulvodynia, and Urinary Incontinence, it assesses urethra mobility during resting and increased intra-abdominal pressure, it can predict surgical outcomes but it still can not be sufficient for surgical decision-making[1]. Q- tip test may be used as a screening test when the urodynamic testing is not available and can also be used in conjunction with the urodynamic test[2].

Procedures[edit | edit source]

Urethral mobility assessment

  • Sterilize the swab cotton with 2% xylocaine jelly.
  • The swab cotton will be inserted gently and slowly into the urethra till no further resistance means the Q-tip has entered the bladder.
  •  Then, gently pull back the cotton swab until increased resistance is met, indicating that the cotton tip is entering the urethra. at ureterovesical junction.
  • The first measure( resting angle) will be taken at this point related to the horizontal line it equals 0 when it is parallel to the ground in people with normal pelvic anatomy.
  • Ask the patient to cough, do Valsalva, or contract abdominal muscles to increase the intra-abdominal pressure.
  • Then the maximum deflection of Q- tip angle is measured. The normal angle from 10- 30, more than 30 considered hypermobility and means descent of the urethrovesical junction and may require surgery.

Vulvodynia assessment

Swab cotton will be pressed with mild pressure perpendicular at different seven areas of the vulvar vestibule (left and right posterior interlabial sulci (grooves between the labia majora and the labia minora); 5-, 6-, and 7-o’clock positions of the introitus; and 8-, 4- o’clock positions of the hymen[3].

Women will rate their pain for each point from (0- 10) while zero no pain/ no discomfort, and if pain and discomfort exist describe it ( burning, sharp, prickly, pressure, irritation, itch).

It is used in women with chronic pelvic pain to provoke vestibulodynia[4]. However a positive swab test is not required to prove the diagnosis of vulvodynia, women may have painful spots during the test in absence of vulvodynia[5].


Evidence[edit | edit source]

Q- tip test has a high rate of false-negative value in older women, it may be negative with no hypermobility existing with Urinary Incontinence, in this condition examination of intrinsic sphincter deficiency should be done.

Sensitivity: it had a sensitivity of 82% when straining angle ≥ 30, and 83% if it is ≥ 40.

Specificity: it had a specificity of 54% when straining angle ≥ 30, 64% if it is ≥ 40.

Reliability: it had good test-retest reliability[7].


It had 83.53% specificity, 100% sensitivity, the PPV= 30.51%, and the NPV= 100%[8]. More studies about the evidence of QTT are still needed.

References[edit | edit source]

  1. Yun JH, Kim JH, Park S, Lee C. Changes in the Q-tip angle in relation to the patient position and bladder filling. BMC urology. 2015 Dec;15(1):1-5.
  2. Robledo D, Zuluaga L, Bravo-Balado A, Domínguez C, Trujillo CG, Caicedo JI, Rondón M, Azuero J, Plata M. Present value of the Urethral mobility test as a tool to assess stress urinary incontinence due to Intrinsic sphincteric deficiency. Scientific Reports. 2020 Dec 2;10(1):1-7.
  3. Reed BD, Plegue MA, Harlow SD, Haefner HK, Sen A. Does the degree of vulvar sensitivity predict vulvodynia characteristics and prognosis?. The Journal of Pain. 2017 Feb 1;18(2):113-23.
  4. Bao C, Noga H, Allaire C, Williams C, Bedaiwy MA, Sadownik LA, Brotto LA, Smith KB, Yong PJ. Provoked vestibulodynia in women with pelvic pain. Sexual medicine. 2019 Jun 1;7(2):227-34.
  5. Vieira-Baptista P, Lima-Silva J, Beires J, Donders G. Women without vulvodynia can have a positive ‘Q-tip test’: a cross sectional study. Journal of Psychosomatic Obstetrics & Gynecology. 2017 Oct 2;38(4):256-9.
  6. MEDICO THEORY. Q-TIP TEST- street urinary incontinence MUST KNOW FINAL YEAR TOPIC . Available from: http://www.youtube.com/watch?v=61EzxtJ98P4[last accessed 29/1/2022]
  7. Swift S, Barnes D, Herron A, Goodnight W. Test-retest reliability of the cotton swab (Q-tip®) test in the evaluation of the incontinent female. International urogynecology journal. 2010 Aug;21(8):963-7.
  8. Papoutsis D, Antonakou A. The Q-tip test of the vulva as a diagnostic aid for vulvodynia: sensitivity, specificity, and predictive values. Journal of psychosomatic obstetrics and gynaecology. 2019 Jun;40(2):90.