Aim: Accurate identification of the nature of an adnexal mass can ensure optimum management and with this aim in mind we applied tests of diagnostic accuracy to the symptom index (SI) and the risk of malignancy index 1 (RMI-1) separately and in combination to differentiate between benign and malignant adnexal masses in women admitted for surgery at three different medical college institutions in India. This was done to frame a referral policy for women with adnexal masses, facilitate triaging and for counseling the woman and her family. Methods: All the participants were given a survey to complete based on which the participants were either SI positive or negative. Ultrasonographic parameters and CA-125 levels were used to calculate the RMI for each participant. Using Histopathology as the gold standard we compared the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios and diagnostic accuracy of the SI and RMI separately and in combination. Results: When compared to the SI the RMI rates higher in all tests of diagnostic accuracy. Sensitivity (SI—41.4% RMI—77.8%) Specificity(SI—73.24%, RMI—80.6%), PPV(SI—38.71% RMI—60.0%), NPV(SI—75.36% RMI—90.6%) and diagnostic accuracy (SI—64% RMI—79.8%) diagnostic accuracy does not improve when the tools are combined. Conclusion: The RMI can be used as a triaging tool and also for framing a referral policy for adnexal masses. For counseling patients with adnexal masses, the RMI through a better option than the SI does not have a good positive or negative likelihood ratio to either rule out or rule in a diagnosis of malignancy in individual cases. Clinical significance: Menopausal status, CA-125, and ultrasound features are much more predictive of the nature of an adnexal mass when compared to symptoms making RMI a better tool for triaging and referral and counseling women with adnexal masses