@JulieB123 OMG. That is sooo hot. Could you tell about a real Qtip test in more detail. When you stand and the doctor is holding your lips open, are you completely nude? Does he spread your lips with the fingers of the same hand, or does he pinch your lips with his fingers and pull them open with two hands?
@JulieB123 probably won't answer this, so I will. The patient is in a gown for both the lithotomy and standing portions of the Cough Stress Test. Total nudity is fantasy, not reality. Why in the world would the doc hold the labia closed? The whole point of the test is to determine if stress incontinence is elicited by coughing. Holding the labia closed would be counterproductive to that end.
The Cough Stress Test begins with the patient in lithotomy position. The bladder is filled with sterile water via a catheter if the patient doesn't have a full bladder. Then the provider opens the labia while the patient is instructed to cough, generally two or three times. If urine leakage is observed, the test is considered positive. If it is not, then the standing test is done.
While standing, the patient holds her gown up, exposing her vulva, and places one foot on the step of the exam table to aid in visualization. The provider typically opens the labia so the urethral meatus can be visualized and the provider can see if there is leakage of urine when the patient coughs.
In the old days, a type of dye was sometimes instilled in the bladder before the test, to aid in identifying urine flow. That's not done so much these days, except maybe by old timers. Again, if leakage is seen, the test is considered positive. If no leakage is observed in either position, the test is negative for stress incontinence, and other tests may or may not be done.
The Q-Tip test and the Cough Stress Test are not the same procedure. The Q-Tip test is done to determine if the patient's bladder neck moves more than approximately 30 degrees while under pressure. This is predicative of the success of surgical treatment for stress incontinence. The Cough Stress Test is diagnostic for stress incontinence itself. If the Cough Stress Test is negative, there's no reason to perform a Q-Tip test.
I don't think you want to see your wife undergo either procedure, because if she does, it likely means that she's having incontinence issues. Neither test is done as a screening test. They are both diagnostic, meaning that problems are suspected.
I'll also add that recent studies show that the results of the urethral Q-Tip test can be replicated by placing the same type of Q-Tip into the vagina up to the level of the bladder neck and asking the patient to do a Valsalva maneuver - which basically means to bear down the pelvic floor muscles while exhaling slowly through the mouth. The studies show that the vaginal test is much more comfortable for the patient than is the urethral test, and is preferred by a majority of patients over the urethral test.
You might also want to Google the Marshall-Bonney test, which is yet another diagnostic test for incontinence in females that you don't want to see your wife go through.