Hysterosalpingography (HSG)

Hysterosalpingography (HSG) is a special type of X-ray procedure used to examine a woman’s uterus (womb) and fallopian tubes. It helps doctors assess the shape and structure of the uterus and whether the fallopian tubes are open or blocked which can be important in investigating infertility or recurrent miscarriages.

Why is an HSG done?

Your doctor may recommend an HSG to:

• Check if your fallopian tubes are open or blocked.
• Assess the shape and structure of your uterus.
• Investigate causes of infertility or repeated miscarriages.
• Evaluate scarring, fibroids, or other abnormalities inside the uterus.
• Check the results of a tubal surgery (e.g., tubal ligation or reversal).

What happens during an HSG procedure?

• You will lie on your back on the X-ray table.
• A speculum is gently inserted into your vagina, and a small tube (catheter) is placed through your cervix into the uterus.
• A special contrast dye is slowly injected through the catheter.
• X-ray images are taken in quick succession to track the dye as it flows through the uterus and fallopian tubes.
• The dye outlines these structures, allowing the doctor to see if the tubes are open and if the uterus has a normal shape.

The procedure usually takes about 15–30 minutes.

Does an HSG procedure hurt?

Some women experience mild to moderate cramping during or shortly after the procedure, similar to menstrual cramps. The discomfort usually lasts only a few minutes. You may take mild pain relief (as advised by your imaging center) before or after the test.

How should I prepare for an HSG?

• The test is generally scheduled after menstrual bleeding ends and before pregnancy could reasonably have occurred; the exact cycle window depends on cycle length and local protocol.
• Follow the center's instructions about intercourse or contraception before the test rather than relying on a fixed calendar day.
• Pregnancy status must be assessed. Testing requirements vary, and a negative test does not replace an accurate history of timing and pregnancy possibility.
• Inform your doctor or radiographer if you are or might be pregnant, have a pelvic infection, or have allergies to contrast dye or iodine.

Can I eat or drink before the HSG?

Yes. There is no need to fast before an HSG. You can eat and drink normally.

What should I expect after the procedure?

• You may have mild cramping or light vaginal spotting for a day or two.
• Avoid sexual intercourse, using tampons, or douching for 24–48 hours afterward to reduce the risk of infection.
• If you experience severe pain, heavy bleeding, fever, or foul-smelling discharge, contact your doctor immediately.

Are there any risks associated with an HSG?

HSG is generally safe, but as with any medical procedure, there are some small risks, including:

• Mild infection or pelvic inflammation.
• Allergic reaction to the contrast dye.
• Light bleeding or cramping after the test.

Your radiographer will take precautions to minimize these risks.

Can an HSG improve my chances of getting pregnant?

Pregnancy rates may be temporarily higher after tubal flushing in some groups, particularly with certain oil-based contrast protocols, but HSG is primarily a diagnostic test and does not guarantee improved fertility. Contrast choice has different benefits and risks and should be discussed with the fertility team.

Can I have an HSG if I am pregnant?

What are the important limitations and safety checks?

Fluoroscopy shows movement or anatomy during a specific examination, but it does not guarantee a diagnosis or exclude every abnormality. Image quality and interpretation can be limited by positioning, movement, body size, retained contrast, overlying structures, incomplete filling, or the patient's ability to complete the study. Further endoscopy, ultrasound, CT, MRI, laboratory testing, or tissue sampling may still be needed.

HSG uses ionising radiation and intrauterine contrast and should not be performed during pregnancy. The team must assess pregnancy possibility and use the lowest exposure that answers the question. Active pelvic infection, unexplained heavy bleeding, and some recent uterine procedures may require postponement or a different plan.

Contrast and preparation are procedure-specific. Barium, water-soluble iodinated contrast, intravenous contrast, and contrast placed into a joint, bladder, uterus, duct, or fistula have different risks. Tell the team about prior reactions, swallowing or aspiration problems, suspected perforation, kidney or thyroid disease, diabetes, medicines, and recent contrast studies. Do not fast, stop medicines, interrupt breastfeeding, or take bowel preparation or antibiotics based only on a general webpage; follow the center's written instructions.

Questions to ask the fluoroscopy team

• What exact question should this examination answer, and is a radiation-free or non-invasive alternative suitable?
• Which contrast route and agent will be used, and what preparation, pregnancy, breastfeeding, allergy, kidney, diabetes, or medicine instructions apply to me?
• Will a catheter, internal examination, sedation, or pain relief be needed, and may I stop the procedure if I am uncomfortable?
• What symptoms require urgent help afterward, when will the signed report be ready, and who will explain the result?

Sources and further reading

• RadiologyInfo.org: Fluoroscopy
• American College of Radiology: Manual on Contrast Media
• RadiologyInfo.org: Radiation safety for children

Conclusion

HSG can assess the uterine cavity and whether contrast passes through the fallopian tubes, but spasm, mucus, technique, and anatomy can produce false blockage or incomplete results. It should be planned with pregnancy and infection safeguards and interpreted with the wider fertility assessment.