How Is Culdocentesis Done?

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

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Depending on the type of fluid withdrawn, the result interpretation involves: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

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


What is pelvic inflammatory disease (PID)? See Answer