Posted October 1, 2022 by Anusha ‐ 2 min read

Culdocentesis is a diagnostic procedure to remove abnormal fluid from behind your vagina in your cul-de-sac or pouch of Douglas. It’s not as widely used as it once was, but can help diagnose infection or medical conditions.

What is Culdocentesis?

  • Culdocentesis is a medical procedure that checks for abnormal fluid behind your vagina and under your uterus in an area called the posterior cul-de-sac.

  • Your healthcare provider inserts a thin needle through your vaginal wall to obtain a sample of fluid from this area for testing.

  • Transvaginal ultrasound has largely replaced culdocentesis because it can detect abdominal and pelvic fluid.

  • Surgeons may use minimally invasive or image-guided surgical techniques instead of culdocentesis.

When is Culdocentesis performed?

  • Certain medical conditions and infections cause irregular fluid to fill your posterior cul-de-sac.

  • Most healthcare providers use an ultrasound to detect fluid behind your uterus.

  • If they suspect the fluid is abnormal, they may perform culdocentesis to extract fluid for testing.

Some reasons for culdocentesis are:

  • Rupturing of an ectopic pregnancy.

  • Pelvic inflammatory disease (PID).

  • Ruptured ovarian cysts.

  • Endometriosis.

  • Uterine fibroids.

  • Trauma to the pelvis.

  • Pain in your pelvis or lower abdomen.

Procedure of Culdocentesis

The steps of the procedure typically involve:

  • Your healthcare provider will perform a pelvic exam and insert a surgical instrument to lift your cervix up. This shouldn’t be painful but may be uncomfortable.

  • You provider numbs an area of your cervix with a local anesthesia.

  • Your provider inserts a thin needle through the wall of your vagina below where your cervix ends. The needle is attached to a syringe that collects fluid.

  • Finally, your provider removes a sample of fluid from your posterior cul-de-sac through the needle.

What do the results of Culdocentesis mean?

  • A normal result means your fluid is clear.

  • Bloody, pus-filled or large amounts of clear fluid may suggest there’s a problem.

  • For example, yellow, pus-filled fluid indicates an infection.

  • Blood that doesn’t clot means an ectopic pregnancy has ruptured.

  • This is because blood from your cul-de-sac area doesn’t clot.

  • The fluid may need drained or treated with antibiotics depending on the test results.

How is ectopic pregnancy diagnosed using Culdocentesis?

  • This procedure was once valuable in diagnosing ruptured ectopic pregnancies with hemoperitoneum (bleeding) when ultrasound wasn’t yet widely available.

  • During this time, ectopic pregnancies weren’t detected until they ruptured.

  • However, ultrasound can detect an ectopic pregnancy before it ruptures which reduces the need for culdocentesis.

Risks of Culdocentesis

Risks of culdocentesis include:

  • Puncturing your uterus or rectum.

  • Infection

  • Puncturing blood vessels, cysts or tumors.

lab-tests lab-investigations investigations cludocentesis

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