Culdocentesis

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.