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.
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.
Puncturing blood vessels, cysts or tumors.