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HSG / Hysterosalpingogram

 What is a hysterosalpingogram?

The HSG or hysterosalpingogram is the standard, basic x-ray study of the uterus. It is designed to evaluate the inside of a uterus (the uterine cavity) and give a crude assessment of whether the fallopian tubes are patent. This basic HSG procedure is offered by most hospital radiology departments and can be performed by a radiologist or a gynecologist.


 How is a hysterosalpingogram performed?

The timing of a HSG is important. The uterine lining should be as thin as possible. for this reason, the hysterosalpingogram is performed shortly after the bleeding from a period has ended but before ovulation occurs. To schedule, a woman would call the office with the first day of her period. The HSG is scheduled for after she thinks her period will be over.

The process is simple. A woman is brought into a special room that has the x-ray equipment. She is asked to lie down and put her legs in stirrups, just as if she were going to have a PAP smear. A speculum is placed in the vagina and the opening to the uterus (called the cervix) is visualized by the doctor. After cleaning the cervix with an iodine solution, a long, narrow, flexible catheter is inserted through the opening of the cervix until the tip is inside the uterine cavity. A balloon on the end of the catheter is inflated to hold the catheter in place. The catheter is connected to some plastic tubing through which a special dye is passed into the uterus. This dye looks like water to the eye but it shows up on x-ray film because it blocks the passage of the x-rays leaving “unexposed film’. Therefore everywhere the dye flows looks white (or black if the image is reversed).

This hysterosalpingogram image shows a normal uterine cavity. The fallopian tubes have not yet begun to fill with dye.

hsg_1

As the dye fills the uterus, x-rays are taken every few seconds, this reveals any abnormalities inside the uterus such as a split cavity, uterine fibroids, uterine polyps or uterine adhesions.

As more dye flows into the uterus, some will begin to fill the fallopian tubes.

hsg_2

The distal most portion of the fallopian tubes have a larger diameter so the hysterosalpingogram image reflects the widening of the the fallopian tubes.

hsg_3

If the fallopian tubes are patent along their entire course, eventually the dye will “spill” out the far side.

hsg_4

The Pain Free HSG

Over the years, many patients have expressed a great deal of fear and anxiety about having the HSG done. They have read in some book or on the internet, or have heard that the HSG is a painful procedure. However, once they completed their HSG with us, they often make comments like:

“That’s it?”
“It’s over already?”
“Really! We are done?”
“I thought it was going to be painful!”

The secret to our pain free HSG is three concepts:

  • Gentle catheter placement. Perfected after performing thousands of procedures
  • Premedication with nonsteroidal anti-inflammatory agents
  • Local anesthetic at the time of the HSG procedure

You will not get this kind of care if you go to the local hospital radiology department!