Hysterosalpingogram (HSG)

What is a Hysterosalpingogram (HSG)?

A Hysterosalpingogram is an x-ray taken of a woman's uterus and Fallopian tubes using a dye that lights up on the x-ray. Most commonly done on women who are having difficulty trying to conceive. It is done to check for any abnormalities and/or blockages of these reproductive structures. If a partial blockage is found in the Fallopian tubes these blockages can be resolved during this test.

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Why Is The Hysterosalpingogram (HSG) Test Done?

The Hysterosalpingogram is most often preformed when a couple is having difficulty trying to conceive. Especially if there are no other apparent health problems preventing them from doing so. The Hysterosalpingogram is used to....

  • Check for any blocked or partially blocked fallopian tubes.
  • Check for any structural abnormalities in the uterus such as polyps, fibroids, tumors or any uterine or tubal scaring.
  • May also be performed after a tubal surgery such as removal of blockages in the tubes, tubal ligation and tubal reversals, to ensure the surgery was successful.

Have You Had a Hysterosalpingogram?

  • Yes, once.
  • Yes, more than once.
  • No, I am to have one performed in the future.
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Does The Hysterosalpingogram (HSG) Test Hurt?

How much a Hysterosalpingogram will hurt is difficult to determine. Every woman's pain tolerance and situation is different. It will depend on what problems are found and possibly treated during the test.

Most commonly, the beginning of the test feels very similar to a pap test. A speculum is inserted into the vagina and swabs are used to clean the cervix. Some pinching and minimal cramping is often associated with this.

When the dye is being injected into the uterus stronger menstrual like cramps may be felt. As well as a "full" feeling in the uterus. If there is any blockages noted in the Fallopian tubes your doctor may inject more dye to try to blow through the blockage. This is often more painful.

Most woman describe the pain of this test as, "like a pap", "very similar to bad menstrual cramps" or "just a little discomfort" . However, some women have been known to experience a higher level of pain during the test. The good news is that if you are one of those women who have a higher level of pain during the test. The pain is very sort lived and the test will rapidly become less painful within a few minutes.

HSG Ashermans Syndrome

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How To Prepare For The Hysterosalpingogram (HSG) Test

Different medical professionals may have you prepare for the test in different ways. Most women are encouraged to take an analgesic for the pain such as Advil about 30-60 minutes prior to the test to help with any discomfort during and/or after the test.Some medical professionals may order a stronger analgesic for you if needed.

Other medications may be also ordered for you such as an antibiotic to help prevent any possible infections. This antibiotic may be taken the day before, the day of the test and the day after. Or it may be just ordered to take after the test.

It is natural to be anxious prior to the test. Especially if you do not know what to expect. Therefore, a sedative my be prescribed to you to help you relax and slightly sedate you for the procedure. This may be very helpful to you if you already suffer from anxiety.

Please let your health care provider know the following....

  • If you are or may be pregnant.
  • When your last menstrual cycle was. There are certain times during your cycle that this test is performed.
  • If you are allergic to the dyes that are used for the x-ray, barium and/or shellfish.
  • If you have pelvic inflammatory disease (PID), any vaginal bleeding, infections and/or any abnormal discharge.
  • If you have kidney disease or any kidney problems.
  • Any medications that you are currently taking.

You may also want to remove any jewelry or other metals as they can interfere with the x-ray machine. It is best to leave your valuables at home before the test.

Although most places can usually provide them for you, take a sanitary napkin with you. Tampons should not be used as they can increase the chances of an infection. There may be some light vaginal bleeding after the test is performed as well as some leakage of excess dye.


Normal Results
Abnormal Results
Shape of uterus is normal
Abnormaly shaped uterus
Shape of Fallopian tubes are normal
Dye does not flow through Fallopian tubes due to scarring, malformation, or blockages
No scarring or damage found
Dye leaks out of uterus due to a tear
No bloackages found and dye flows freely from uterus, through tubes and spills into the abdomen
Polyps, tumors or fibroids found in the uterus
No tumors, polyps, or fibroids present
 

What Will Happen During The Hysterosalpingogram (HSG)?

You will be happy to know that this procedure is very quick and you will likely spend more time in the waiting room than having the actual procedure done. Here are the steps...

  • You will undress from the waist down. You will be given a gown and/or a sheet to cover yourself.
  • The procedure will be explained to you and you will be asked to sign a consent form stating that you agree to have this test done.
  • You will lay on a table just the same as a pap test would be preformed. With your legs spread open. But an x-ray machine will also be placed above you to take "real-time" photographs of your uterus and Fallopian tubes.
  • A speculum will be inserted into your vagina to keep it open and keep your cervix in view. Lights may be adjusted to give your medical provider a better view. Many women find the speculum uncomfortable but not usually painful.
  • The cervix will be cleaned and some local anesthetic may be injected into the cervix to prevent discomfort. This often feels very similar to a pap test and some pinching may be felt.
  • A clamp my be inserted to keep your cervix open and in place. More discomfort may be felt here especially if the cervix is closed tight.
  • A small catheter is then inserted through the cervix and into the uterus. This also may feel like a pinch.
  • The speculum is then removed as everything is in place and the cervix no longer needs to be in view.
  • Dye is then injected into the uterus and will begin to flow through the Fallopian tubes if there are no blockages. The dye will glow on the x-ray screen. You may be asked to move in different positions to get more accurate pictures and help the dye flow through your tubes. If your tubes are open the dye will flow through them and spill into your abdomen where it is naturally absorbed by your body. If there are some blockages your medical provider may inject more dye to try to unblock your tubes. You may feel some fullness in your uterus and some menstrual like cramping. Some women only experience minor cramping while others may feel more intense cramping. This usually only lasts a few minutes and the cramping will begin to subside
  • Once the pictures have been taken the catheter is removed. You may lay on the table for as long as you need as the cramping subsides.
  • Once you feel well enough, the procedure is complete and you are able to go clean up and go home.
  • Results may be given to you after the test is complete or you may need a follow-up apportionment with your health care provider.

What Are The Risks and Complications of A Hysterosalpingogram (HSG)?

Risks and complications of the Hysterosalpingogram include....

  • Allergic reaction to the dye. Please let your medical provider know of any allergies you may have.
  • Cell damage due to the low levels of radiation used with the x-ray. The chances of this risk are very low.
  • Pelvic infection. This is why antibiotics may be prescribed for the test. Please let your health care provider know if you are experiencing any of the following symptoms. Fever, severe pain/cramping, vomiting, foul smelling discharge, fainting, heavy or prolonged vaginal bleeding in the next few days following the test.
  • Uncommon damage to the uterus such as perforation.

Does a Hysterosalpingogram Increase Fertility

Some people believe that the Hysterosalpingogram test increases fertility, though, test is not performed in order to increase fertility but rather to diagnose or rule out any fertility problems. However, if a partially blocked Fallopian tube is discovered and the dye used during the test is able to unblock the tube or both tubes fertility may be increased due to this.

Many women claim to have become pregnant immediately following the test, though, it is unsure whether or not the pregnancy is the direct result of having the test done or just coincidence. It may be said that the oil-based dye (Ethiodol) used in some tests (a water-based dye is often used instead) actually improves the chances of conceiving. However, there is no medical evidence whether this is actually true or why it would improve fertility.

Was The Hysterosalpingogram Painful?

  • I did not feel much at all.
  • No, just a little uncomfortable.
  • Similar to a pap test.
  • Yes, cramping like a bad period.
  • Yes, very painful.
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