HSG (Hysterosalpingogram)

Check for Blocked Fallopian Tubes and Polyps, Fibroids, Adhesions & Scar Tissue at Our Durham, NC Clinic

HSG (hysterosalpingogram) is a procedure to test for blocked fallopian tubes via polyps, fibroids, adhesions, and scar tissue in which a physician injects contrast dye through the cervix into the uterus while observing with fluoroscopy (live X-rays).

This procedure is done in conjunction with radiology and will have to be scheduled for a Tuesday afternoon with Dr. Hurd or Wednesday afternoon with Dr. Muasher.

It is always comforting for you to be accompanied by a family member or friend however, because it is an x-ray procedure, they will have to wait in the waiting room during the HSG. You will not be sedated for this procedure and can drive home.

How Testing for Blocked Fallopian Tubes Works

Since X-rays normally pass through soft tissue, a contrast agent must be used to show the cavity of the uterus and the fallopian tubes. The contrast agent is often referred to as the “dye,” though it is a clear liquid. Iodine is the active agent in the liquid that prevents the X-rays from reaching the film.

By blocking the X-rays, the film has areas that are not exposed and remain clear. The tissues can readily absorb the contrast agent, or dye, so the liquid that does not come out at the completion of the test will pass out in the urine within several hours.

What to Expect

The procedure involves the following steps:

  1. A speculum — a visual inspection instrument — is placed into the vagina for visualization of the cervix.
  2. A cleaning solution is used to clean the cervix and vagina.  This is called betadine and is a brown soapy solution.
  3. Sometimes an instrument may be used to grasp the cervix to allow traction. A pinch, like an injection, may be felt at this point, but this usually passes very quickly.
  4. A flexible tube called a cannula, with a rubber stopper on the end, is placed against the opening of the cervix. This plugs the opening of the cervix so that as the “dye” is injected, it does not spill back into the vagina.
  5. The speculum is removed and the patient is positioned correctly under the X-ray machine. A physician is present to perform fluoroscopy, or real-time X-ray images.
  6. As the contrast is slowly injected into the uterus, the image of the uterine cavity and fallopian tubes becomes visible on the monitor. Patients and family members are encouraged to watch the monitor as the procedure is being done.
  7. The physician takes a still X-ray images that demonstrates the HSG findings. Ideally, the contrast will appear to spill out of the ends of the fallopian tubes.

After the still X-ray has been completed the procedure to test for blocked fallopian tubes via polyps, fibroids, adhesions, and scar tissue is finished. Most patients are surprised at how quickly the actual procedure can be accomplished.  Results are given to the patient same day before they leave the room.

Patients with blocked fallopian tubes will either have tubes that do not fill with contrast, or tubes that fill without spill. Often dilated tubes will be demonstrated if the obstruction is at the fimbriated end of the fallopian tube.

Preparing for an Appointment

Schedule an HSG for the week immediately after your menses, ideally between cycle days 5 and 12. The physician who performs the HSG procedure will also briefly review the results with you after it is completed.

It is recommended that you have a small lunch and take 600 to 800 mg of ibuprofen one hour before the procedure. If you cannot take ibuprofen, 500 mg of Tylenol would be helpful to reduce cramping during the procedure.



The most common risk during an HSG procedure is cramping. As the contrast fills the uterus and fallopian tubes, some muscles are stretched. These muscles respond with reflexive contractions that cause cramping. Spasm of the tubes tends to be more uncomfortable than uterine cramps but lasts a shorter amount of time.

Not all patients experience cramping, but it is a good idea to pre-medicate with an anti-inflammatory medication such as Motrin 800 mg or Advil Extra Strength. Mild cramping may continue throughout the remainder of the day. More intense cramping usually subsides shortly after the procedure.


Another common risk is spotting. The instrument used to hold the cervix may cause light spotting that tends to be self-limited. A pad is usually provided to protect clothing.

Dizziness and Nausea

A vagal response may be one of the most concerning reactions to someone who is not properly prepared. This reaction involves the activation of a nerve that normally controls parts of the body such as the intestines, stomach, pulse, and blood vessels.

Manipulating the uterus and cervix can trigger the vagal response. This can cause a hot flush followed by dizziness, nausea, and even a blackout. Sitting or lying down helps to counteract this phenomenon, which usually passes within several minutes.

Knowing that this is a possibility often removes a large portion of the anxiety that can accompany a vagal reaction.


Infection to the uterus and tubes is theoretically possible but very rarely seen. Because the contrast is injected through the uterus and tubes, bacteria can enter the reproductive tract. The female tract is usually capable of warding off infection.

Because there is concern for a patient’s tubes in terms of infection and damage, patients are given prophylactic antibiotics. Following the procedure, any disproportionate pain, fever, or unusual symptoms should be reported.

Radiation Exposure

Early pregnancies could potentially be exposed to radiation. Early exposure will have not have any effects or result in miscarriage. There are no known mutations that occur from radiation exposure at these levels in early pregnancy.

Patients who take pregnancy tests prior to cycle day 21 are not likely to have a positive test even if they are pregnant. Since there are no “perfect” tests to completely exclude pregnancy, there will always be a small risk that you could be pregnant and undergo an HSG.

We do have you give a urine sample for a urine pregnancy test prior to the exam start.


Some patients have allergies to iodine compounds like intravenous contrast dye. Patients with a history of anaphylaxis are the most at risk group. Premedication can be used with mild allergies.

Please discuss this issue with your physician at the time you are told you need to have this procedure performed, to avoid showing up at the clinic and having to reschedule your HSG.