Understanding Hysterosalpingography (HSG)

Hysterosalpingography (HSG), also known as an uterosalpingography, is a medical examination of a woman’s uterus and fallopian tubes done with the use of an x-ray.

Purpose of a HSG

The HSG examination is used mostly to determine the reason for women experiencing difficulties with conceiving. With this type of technique, the woman’s uterus and fallopian tubes can be assessed for any abnormalities or blockages. Scarring or other abnormalities can be discovered with this x-ray technique.

This method of screening can also be performed to observe the fallopian tubes after a tubal surgery to see if the tubes are fully blocked if sterilization was requested or to see if they are completely opened (if this was the intent of the surgery). Medical studies indicate that 30 percent of infertility cases are due to blocked or damaged fallopian tubes. This procedure can usually detect these complications, but a HSG may not be able to properly assess the difficulties in every case.

Adhesions and uterine fibroids (benign or non-cancerous smooth-muscle tissue tumors on the wall of the uterus) or tumors can be assessed with this x-ray as well.

The Procedure

The patient is asked to lie down on a special table to prepare to have the special x-ray test. Usually the knees are bent upwards or on stirrups, with the position similar to when the woman is having a pap test performed.

A speculum (a medical instrument used to widen the opening of a body part) is placed into the vagina for easier cleaning and viewing of the cervix. Sometimes a local anesthetic is injected into the cervix to relieve any pain. Some cramping is common during the procedure and may also be experienced after the test is completed.

Die is then inserted into the cervix and fills the uterine cavity by way of a cannula (small flexible tube) or with the use of a thin plastic tube with a small balloon at the end of it. This balloon secures the tube in place in the uterus. The speculum is then taken out of the vagina; the x-ray is then done.

Often, the x-ray is suspended over the table. A monitor resembling a television is also utilized and can be in the room itself or in an adjacent room. The woman is usually asked to remain on the table for a few minutes as this will normally relieve any minor cramping. If an abnormality is detected, the woman may also be asked to stay on the table for an additional 30 minutes so that repeat x-rays may be performed.

If the fluoroscopy method is used, the images will be transformed to videos. This type of x-ray examines the tissues and deeper parts of the body by converting the images into the movie-like videos on a screen.


Risks for a HSG include an allergic reaction to the dye to perform the x-ray examination, infection of the fallopian tubes, or a perforation (hole puncture) of the uterus itself.

Women who suspect being pregnant should not have this procedure nor should a HSG be performed when there is a pelvic infection.

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