One hundred forty fine needle aspirations were performed on 124 patients with a variety of gynecologic conditions. The primary goal of this study was to investigate the adequacy of this technique in the primary diagnosis of pelvic masses and in the detection of persistent or recurrent gynecologic malignancies following irradiation or chemotherapy. In this, the first of two articles, the clinical aspects of the procedure, including clinical indications and the different approaches and pelvic sites of fine needle aspiration, are discussed. The simplicity and lack of complications of the method, combined with a high degree of accuracy in predicting the histologic picture of various lesions, merit wider application of this technique as a reliable diagnostic tool in gynecologic oncology.