Gynecological Conditions DBQ explained

What this DBQ covers

The gynecological questionnaire contains separate sections for different anatomical areas and diagnoses, including endometriosis, pelvic organ prolapse and removal of reproductive organs. It also addresses symptoms, treatment, testing and functional effects. The breadth of the form does not mean every section applies. The clinician should use the actual diagnosis, examination and treatment history to identify the relevant findings.

The important sections, explained

Symptoms and response to treatment

The form asks about symptoms, prior treatment and whether treatment is currently required. Describe the pattern over time and what has changed with care. If symptoms vary with a cycle, a dated record may help explain that pattern. Distinguish a treatment that was recommended, one you completed and one you currently use. The clinician assesses how the documented diagnosis and treatment relate to the symptoms; you do not need to choose a severity category.

Read the official form: page 2

Different organs and procedures

Separate sections address removal of the uterus or ovaries, endometriosis, prolapse and other diagnosed conditions. A hysterectomy concerns the uterus; it does not by itself say whether either ovary was removed. Bring the operation report rather than relying on a general description such as everything was removed. The examiner can identify the actual anatomy and procedure, then consider ongoing symptoms, treatment and any other findings that require their own section.

Read the official form: page 4

How to prepare useful information

Bring procedure and pathology reports when available, together with a timeline of symptoms and treatment response. Explain ongoing effects on daily activities in your own words, including concerns that may be difficult to discuss. The type and date of surgery can matter to an accurate history, so avoid relying only on a general description such as a pelvic operation. The clinician should assess the cause of symptoms that could involve more than one condition.

Records to gather

Start with records you already have. Bring the relevant information to your clinician and explain any gaps or uncertain dates.

• Gynecology notes, relevant imaging or pathology and the documented diagnosis.
• Operative reports identifying procedures and dates, plus prescribed treatment.
• A factual symptom timeline and examples of effects on ordinary activities or routines.

A detail that is easy to miss

Do not assume that all pelvic pain has the same cause or that one operation answers every section. Identify established diagnoses and concerns still being evaluated. When describing treatment, include whether symptoms persisted, improved or changed. Keep the description relevant and factual; detailed personal information unrelated to the medical assessment is not needed to make the history useful.

Find your way around the official form

These section headings come from the linked VA PDF. Each link opens the page where the section begins. Read the form's own instructions for the full questions and any required attachments.

1. SECTION 1 - DIAGNOSISPage 1
2. SECTION 2 - MEDICAL HISTORYPage 2
3. SECTION 3 - SYMPTOMSPage 2
4. SECTION 4 - TREATMENTPage 2
5. SECTION 5 - CONDITIONS OF THE VULVA OR CLITORISPage 3
6. SECTION 6 - CONDITIONS OF THE VAGINAPage 3
7. SECTION 7 - CONDITIONS OF THE CERVIXPage 4
8. SECTION 8 - REMOVAL OF THE OVARIES OR UTERUSPage 4
9. SECTION 9 - CONDITIONS OF THE FALLOPIAN TUBESPage 4
10. SECTION 10 - CONDITIONS OF THE OVARIESPage 5
11. SECTION 11 - INCONTINENCEPage 5
12. SECTION 12 - FISTULAEPage 5
13. SECTION 13 - ENDOMETRIOSISPage 6
14. SECTION 14 - PELVIC ORGAN PROLAPSEPage 7
15. SECTION 15 - TUMORS AND NEOPLASMSPage 7
16. SECTION 16 - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 8
17. SECTION 17 - DIAGNOSTIC TESTINGPage 9
18. SECTION 18- FUNCTIONAL IMPACTPage 9
19. SECTION 19 - FEMALE SEXUAL AROUSAL DISORDER (FSAD)Page 9
20. SECTION 20 - REMARKSPage 10
21. SECTION 21 - EXAMINER'S CERTIFICATION AND SIGNATUREPage 10

Who completes the clinical sections?

The healthcare provider completes the clinical assessment, identifies the records reviewed, and signs the questionnaire. You can gather records and describe symptoms and daily limitations. Measurements, diagnoses, and clinical conclusions belong to the examiner.

Check the official form's instructions with your provider before the appointment, including any examination or testing requirements. VA does not pay or reimburse the costs of having a private DBQ completed or submitted.

A completed DBQ can help document the medical condition. Whether it also answers a particular service-connection question depends on its content and the other evidence. VA may verify the form or request another examination.

Common questions

Do I need to have every condition listed on this questionnaire?

No. The form covers many possible diagnoses through separate sections. Only the portions relevant to your medical findings should be completed. A symptom that appears in several sections does not establish several diagnoses; the evaluating clinician should make that distinction.

Does a hysterectomy mean the ovaries were also removed?

Not necessarily. The form asks separately about removal of the uterus and removal of the ovaries. The operative report can clarify what was done. If you are unsure, tell the clinician rather than filling in an anatomical conclusion from memory.

Can I bring a symptom calendar?

A concise calendar can help explain timing, frequency and the effect on daily activities, especially when symptoms vary. Identify the period it covers and any treatment changes. It supports your history while the clinician determines the diagnosis and clinical significance.