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.


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.


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


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


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!