How Is Culdocentesis Done?

• How To Interpret Results
  • How are the results of culdocentesis interpreted?
• Preparation
  • How to prepare for a culdocentesis?
• What To Expect
  • What to expect after the culdocentesis procedure?
• Complications
  • What are the complications of the culdocentesis procedure?

Culdocentesis is a procedure to examine any abnormal fluid in the pouch-like space just behind the vagina

Culdocentesis is a procedure to examine any abnormal fluid in the pouch-like space just behind the vagina (cul-de-sac or pouch of Douglas).

In the culdocentesis procedure:

• The physician will first perform a pelvic examination
• Lying in the same position with your head elevated to 60 degrees, the physician inserts a lubricated tool, known as a speculum, to examine the cervix (the neck of the womb)
• Next, the physician cleanses the vagina and cervix with antiseptic and applies 2% Lidocaine gel to the vaginal lip or cervical lip
• Using a tool called a tenaculum, the physician grasps the cervix and lifts to expose the vaginal fold (posterior fornix)
• Next, the physician injects normal saline into the cul-de-sac and empties it. After injecting the normal saline, the physician pulls back the syringe plunger while slowly withdrawing the needle
• The fluid collected is sent for analysis
• If there’s no fluid collected in the first attempt, the physician withdraws the needle and then reintroduces it

Depending on the type of fluid withdrawn, the result interpretation involves:

• A small amount of clear fluid is normal, but the chances of ovarian cyst, unruptured ectopic pregnancy (pregnancy at a site other than the womb), tubal infection, or other disorders can be a possibility
• No fluid in the cul-de-sac can also be a normal finding
• Nonclotting blood indicates active bleeding from a ruptured ectopic pregnancy
• Clotting blood indicates blood from the vein or artery during an aspiration
• The presence of pus indicates an infection, such as pelvic inflammatory disease

To prepare for culdocentesis, you have to follow these instructions:

• Detail your medical and medication history to your physician
• Undergo a pelvic examination for the physician to identify the abnormality of the cul-de-sac
• Understand each step of culdocentesis to know what to expect from the procedure
• Give your informed consent after understanding the procedure thoroughly
• You may need to walk or sit upright for 10 to 15 minutes to allow the fluid to pool into the cul-de-sac
• Inform about any drug allergies or substance allergy to your physician
• Quit cigarette smoking and other nicotine products before the procedure
• Avoid alcohol for a few days before the surgery
• You may have to undergo specific tests before the procedure, which include:
  • Blood tests and urine analysis
  • Computed tomography (CT) scan
  • Ultrasound
  • X-ray of the lower abdomen

After a culdocentesis procedure:

• You may resume your daily routine
• To relieve minor pain, the physician may prescribe painkillers
• You have to notify your physician if you notice:
  • Excessive vaginal bleeding (more than one pad per hour)
  • Fever
  • Nausea or vomiting
  • Worsening or persistent lower abdominal pain
  • Pus-like discharge from the vagina

The complications of culdocentesis procedure include:

• Puncture/injury of adjacent organs
• Infection
• Bleeding
• A false result
• Leakage of fluid into the uterus