One hundred six consecutive women who came to our clinic complaining of urinary incontinence underwent complete urodynamic evaluation. Urologic questions, pelvic examination findings, and the Q-tip cotton swab test results were examined to determine their ability to predict genuine stress incontinence (N = 59) versus other urologic disorders (N = 47). The symptom of stress incontinence, moderate to severe cystocele, and Q-tip cotton swab test result greater than or equal to 30 degrees were more common in women with genuine stress incontinence. Of the other urologic symptoms, only sensory urgency and enuresis were significantly associated with overactive detrusor function and voiding disorders. The combined findings of stress incontinence, cystocele, and no sensory urgency correctly identified 22% of women with genuine stress incontinence and eliminated 96% of women with other urologic disorders. Stress incontinence, moderate to severe cystocele, and no sensory urgency had a positive predictive value of 100%, but a sensitivity of only 10%. When used in series, the Q-tip cotton swab test contributed no additional information to that found by history taking and physical examination.