
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
How are the results of culdocentesis interpreted?
Depending on the type of fluid withdrawn, the result interpretation involves: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
How to prepare for a culdocentesis?
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
What to expect after the culdocentesis procedure?
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
What are the complications of the culdocentesis procedure?
The complications of culdocentesis procedure include:
- Puncture/injury of adjacent organs
- Infection
- Bleeding
- A false result
- Leakage of fluid into the uterus

QUESTION
What is pelvic inflammatory disease (PID)? See AnswerReferences
https://emedicine.medscape.com/article/83097-overview#a8
https://www.uptodate.com/contents/culdocentesis#H5
https://www.uptodate.com/contents/culdocentesis#H5
Complete List
Top How Is Culdocentesis Done? Related Articles
Cervical Cancer
Cervical cancer is cancer of the entrance to the womb (uterus) caused by the human papillomavirus (HPV). Regular pelvic exams, Pap testing, and screening can detect precancerous changes in the cervix. Cervical cancer can be prevented by a vaccine. The most common signs and symptoms are an increase in vaginal discharge, painful sex, and postmenopausal bleeding. The prognosis and survival rate depend upon the stage at which the cancer was diagnosed.Cervical Cancer Quiz
How is cervical cancer different from other cancers? Take this quiz to learn the basics of cervical cancer.Cervical Cancer Symptoms, Stages, and Treatment
Cervical cancer is typically caused by HPV infections. Learn about vaccines to prevent cervical cancer. Get information about cervical cancer symptoms, stages, life expectancy, and available treatment options.Does the Cervix Grow Back After Conization?
Conization of the cervix or cone biopsy is a surgical procedure that involves the removal of a cone-shaped wedge from the cervix (mouth of the uterus). It may be performed for the diagnosis of abnormal areas in the cervix, which may be cancerous or potentially cancerous. Conization is most commonly performed to examine such areas and then take a biopsy for microscopic examination.What Are Polycystic Ovarian Syndrome (PCOS) Symptoms?
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.What Does Culdocentesis Mean?
Culdocentesis is the puncture and aspiration (withdrawal) of fluid from the pouch of Douglas or rectouterine pouch. Culdocentesis used to be a valuable procedure for the diagnosis of ectopic pregnancy. The procedure involves the introduction of a needle through the vaginal wall into the pouch of Douglas.What Does the Conization of Cervix Mean?
The cervix is the mouth of the uterus that opens further into the vagina. Conization or cone biopsy of the cervix is a surgical procedure in which a small cone-shaped or cylindrical wedge of tissue is removed from the cervix (mouth of the uterus).