Hysterosalpingography

Definition

Hysterosalpingography is an x-ray of the uterus and fallopian tubes that involves the injection of contrast (dye) through the cervix.

Alternative Names

HSG; Uterosalpingography; Hysterogram; Uterotubography

How the test is performed

The exam takes place in a radiology department using an overhead x-ray machine. You will lie on a table beneath the x-ray machine and place your feet in stirrups, like during a pelvic exam. A speculum is placed into the vagina, and the cervix is cleaned.

A thin tube (catheter) is placed in the cervix. Contrast passes through this tube, filling the uterus and fallopian tubes. The contrast makes the structures visible when the x-rays are taken.

How to prepare for the test

Because there's a risk of infection, you may be prescribed antibiotics to take before and after the procedure. Your health care provider may also supply drugs to help you relax during the procedure. Be prepared to sign a consent form before the test begins and to wear hospital clothing. Often the test will be scheduled in the week following your period or toward the end of your period, to ensure that you are not pregnant during the test.

Inform your health care provider of any allergic reactions to contrast you may have had in the past.

You can eat and drink normally before the test.

How the test will feel

The test feels much like a vaginal examination associated with a Pap smear. You may have menstrual-type cramping during or after the test. You may experience some pain if the contrast leaks into your abdominal cavity.

Why the test is performed

This test allows the health care provider to see the structures of the uterus and fallopian tubes, and to determine if there are any blockages or other problems. The test is usually done as part of an infertility examination. It may also be done after a permanent sterilization procedure to confirm that the tubes are fully blocked.

Normal Values

Normally, all genital structures are there and are normal, without defects of any kind. Contrast can normally be seen leaking out the fallopian tubes into the abdominal cavity.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal results may indicate any of the following:

• Developmental disorders
• Intrauterine adhesion
• Obstruction of the fallopian tubes
• Pregnancy outside the uterus (ectopic pregnancy)
• Presence of foreign bodies
• Scarring
• Traumatic injury
• Tubal adhesions
• Uterine tumors

What the risks are

• Allergic reaction to the contrast
• Endometrial infection (endometritis)
• Fallopian tube infection (salpingitis)
• Perforation of (poking a hole through) the uterus

Special considerations

This test should not be performed if you have pelvic inflammatory disease (PID) or are experiencing unexplained vaginal bleeding.

After the test, report any signs or symptoms of infection to your health care provider immediately. These include foul-smelling vaginal discharge, pain, or fever.

References

Katz VL. Diagnostic Procedures: Imaging, Endometrial Sampling, Endoscopy: Indications and Contraindications, Complications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 11.