Step‑by‑Step Walkthrough of the Hysterosalpingography (HSG) Procedure

Preparing for the Hysterosalpingography Appointment

Your doctor will usually schedule the HSG test within the first half of your menstrual cycle, typically between days 6 and 10 after the start of menstruation. Timing reduces the chance of interfering with a potential early pregnancy and ensures the uterine lining is thin enough for clear imaging. You will receive specific instructions about the exact day to come in.

Before the appointment, inform the radiology team about any allergies, especially to iodine or contrast agents, and mention any current medications, including over‑the‑counter pain relievers. Some clinicians prescribe a short course of antibiotics to lower the risk of infection, particularly if you have a history of pelvic inflammatory disease. If you take blood thinners, you may need to adjust them under medical supervision.

On the day of the test, wear comfortable clothing that is easy to remove, as you will change into a hospital gown. Most facilities do not require fasting, but you may be asked to empty your bladder shortly before the procedure to improve comfort and image quality. Bring a list of any medications you are taking and your insurance information for check‑in.

Arrival, Positioning, and Equipment Overview

When you arrive at the radiology department, you will check in at the front desk, show your identification, and complete any remaining paperwork. A nurse or technologist will then escort you to a private changing area where you put on the gown. Afterward, you lie on an examination table that can be tilted slightly to help the contrast flow.

The key pieces of equipment are a fluoroscopic X‑ray machine, a thin catheter (often called a cannula) that is placed through the cervix into the uterine cavity, and a syringe containing a water‑soluble contrast medium. The fluoroscope provides real‑time images on a monitor, allowing the physician to watch the contrast move through the uterus and fallopian tubes as it is injected.

Consider Maya, a 32‑year‑old woman who has been trying to conceive for eight months. She arrives at 9:00 am, checks in, changes into the gown, and lies on the table. The technologist explains each step, answers her questions about discomfort, and confirms that she has no known iodine allergy before proceeding. She rates her anxiety as moderate and the technologist reassures her that most women describe the sensation as mild cramping.

Contrast Injection and Real‑Time Imaging

The physician gently inserts the speculum to visualize the cervix, then cleans the area with an antiseptic solution. A thin catheter is threaded through the cervical opening into the uterine cavity. Once the catheter tip is confirmed to be inside the uterus, the contrast medium is prepared for injection.

The contrast is injected slowly under low pressure to allow the radiologist to observe how it fills the uterine cavity and travels into the fallopian tubes.

As the contrast flows, the fluoroscope captures a series of X‑ray images that appear live on the monitor. The images show the outline of the uterine cavity, the shape of the fallopian tubes, and whether the contrast spills freely into the peritoneal cavity at the tube ends. This real‑time view helps the doctor detect any blockages, abnormalities, or malformations.

For Maya, the technologist observes the contrast filling her uterine cavity smoothly, then see it travel through both fallopian tubes. A few seconds later, the contrast spills out of the tube ends into the surrounding pelvic space, indicating that each tube is open. The physician notes the timing and saves a few representative images for the radiologist’s review.

Interpreting the Hysterosalpingogram Images

After the procedure, a radiologist examines the saved images. A normal study shows uniform filling of the uterine cavity, symmetric outlines of both fallopian tubes, and free spill of contrast from the fimbrial ends into the peritoneal cavity. Any deviation from this pattern prompts further evaluation.

The radiologist also measures the diameter of the uterine cavity and notes any filling defects, such as polyps, fibroids, or adhesions that might distort the contour.

Common findings that suggest a blockage include absent or delayed contrast flow beyond a certain point in a tube, a tapered or “beaked” appearance of the tube lumen, or contrast that stops abruptly at a proximal segment. Distal blockages are seen when contrast fills the tube but does not spill out the fimbrial end.

In Maya’s case, the radiologist notes that the uterine cavity fills evenly, both tubes show smooth, continuous contrast columns, and contrast spills freely from each fimbrial tip. The report concludes bilateral tubal patency with no intra‑uterine abnormalities, and the findings are sent to her obstetrician‑gynecologist for discussion. Her doctor will review the report and advise whether any further testing or treatment is needed based on her fertility goals.

Sensations During the Procedure and Immediate Aftermath

Most women describe the sensation as a cramping feeling similar to menstrual pain, which may intensify briefly when the contrast is injected. Some also report a warm flush or a feeling of pressure in the lower abdomen. These sensations usually subside within a few minutes after the injection ends.

The entire procedure typically lasts between ten and twenty minutes, depending on how quickly the contrast moves and how many images are needed. After the catheter is removed, you may notice a small amount of clear or slightly bloody discharge from the vagina, which is normal.

Maya rates the cramping as a 3 out of 10 on a pain scale, describing it as noticeable but tolerable. She feels a brief warm sensation as the contrast enters her uterus, then the feeling fades. After the catheter is withdrawn, she observes a light pink discharge that stops within an hour, and she is able to resume her usual activities later that day.

Aftercare, Possible Side Effects, and When to Seek Help

You can usually return to normal activities immediately after the HSG, although many clinicians advise avoiding intercourse, tampon use, or douching for 24 hours to reduce any risk of infection. Drinking plenty of water helps flush the contrast agent from your system. Over‑the‑counter analgesics such as ibuprofen or acetaminophen may be taken if you experience lingering discomfort.

Side effects are generally mild and temporary. Light spotting or spotting that lasts a day or two is common. Rarely, a woman may develop pelvic infection, experience an allergic reaction to the contrast (such as rash, itching, or difficulty breathing), or feel faint. Severe pain, heavy bleeding, or fever above 38 °C (100.4 °F) warrants prompt medical attention.

Maya experiences only mild cramping that resolves after she takes an ibuprofen tablet. She notices a tiny amount of brownish discharge for the next morning, which disappears by evening. Her temperature remains normal, and she reports no unusual symptoms, so she continues with her planned fertility‑tracking routine. She schedules a follow‑up visit with her obstetrician‑gynecologist to discuss the results and next steps.