Culdocentesis

Description
Culdocentesis is a diagnostic procedure used to obtain a fluid sample from the cul-de-sac, a pouch located between the uterus and rectum in the pelvic cavity. This rectouterine pouch is also called the pouch of Douglas.

Purpose
Culdocentesis is an invasive diagnostic aid used to evaluate emergency conditions affecting the abdomen or pelvis. The need for culdocentesis has decreased significantly due to the development of less painful procedures with fewer complications. For example, abdominal and pelvic ultrasounds (using sound waves to create an image of internal body parts) provide excellent information with minimal discomfort.

Indications
Culdocentesis may be used in an emergency situation whenever material related to the abdominal cavity is needed to help diagnose a specific condition and determine the need for surgical intervention. These conditions include:
pelvic bleeding
ruptured ovarian cyst
ectopic pregnancy (when a fertilized egg develops in one of the fallopian tubes)
ovarian cancer
pelvic inflammatory disease (an infection of the female reproductive organs)
pelvic infection

Patient preparation
No specific preparation is necessary. Before the procedure, however, make sure you understand your doctor's instructions on postprocedure care.

Procedure
The procedure may be done in your doctor's office or the hospital. Lying in the same position as you would for a pelvic exam, the doctor will place a speculum and then insert an instrument called a tenaculum into your vagina. The doctor will use the tenaculum to gently pull up the cervix and reach the cul-de-sac. Typically, the vaginal membrane of the cul-de-sac will be cleaned with a providone-iodine solution. The area may also be anesthetized to help minimize the discomfort. Then, a needle will be inserted into the cul-de-sac and the fluid sample will be taken.

Postprocedure care
You may experience slight vaginal bleeding and mild pain after the procedure, but you should be able to resume your normal activities quickly. Your doctor may ask you to use sanitary pads instead of tampons during your next period. Ask your doctor when you can resume sexual activity and whether you need to alter your method of birth control.

Benefits
Culdocentesis is a minor procedure with few complications.

Risks
Possible risks include perforation of your bowel, bleeding and infection. The procedure can sometimes be painful.

Considerations
If you have a mass in your cul-de-sac, your uterus is tipped in the wrong direction, or you have a bleeding disorder, you may not be a candidate for culdocentesis. The test is typically not part of the routine screening for ovarian cancer because of its low sensitivity for detecting the disease in an early stage.