A hysterosalpingography (HSG) is a specialized X-ray procedure that uses a contrast dye to visualize the inside of the uterus and the fallopian tubes. This diagnostic test is a common component of a fertility evaluation, helping physicians determine if the fallopian tubes are open and if the uterine cavity has any structural abnormalities. Proper preparation is necessary to ensure accurate results and a safe procedure. This guide details the steps for preparing for an HSG, including medical clearance, managing discomfort, and understanding the logistics.
Required Timing and Medical Clearance
The precise timing of the HSG procedure within the menstrual cycle is important for safety and accuracy. The test must be scheduled during the follicular phase, typically between Cycle Days 6 and 12, counting the first day of full flow as Day 1. This window ensures that menstruation has ended, preventing blood from obstructing the images, and that the procedure occurs before ovulation.
Performing the HSG before ovulation eliminates the risk of disrupting an early, unrecognized pregnancy, as the X-ray and contrast dye can be harmful to a developing embryo. To confirm safety, a negative pregnancy test, usually a urine test, is mandatory and performed within 24 hours of the procedure. Patients are also advised to avoid unprotected intercourse from the first day of the menstrual period until the test is completed.
Screening for reproductive tract infections before the HSG is a significant safety step. Introducing the contrast dye into the uterus carries a small risk of spreading existing infections, such as Chlamydia or Gonorrhea, into the fallopian tubes, potentially leading to pelvic inflammatory disease. Patients must confirm they have recent negative test results for common sexually transmitted infections with their ordering physician. Some physicians prescribe prophylactic antibiotics, such as doxycycline, starting the day before the procedure, especially for patients with a history of pelvic infection.
Preparing for Discomfort and Anxiety
Many patients are concerned about potential pain during an HSG, which is typically described as intense menstrual cramping. To manage this discomfort, it is recommended to take a dose of an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as 800 milligrams of ibuprofen, 30 to 60 minutes before the scheduled appointment. This ensures the medication is active in the bloodstream before the most uncomfortable part of the procedure begins.
The cramping sensation occurs when the contrast dye is injected, causing the uterus to contract as the fluid fills the cavity and pushes through the fallopian tubes. The actual procedure is brief, often lasting only five to fifteen minutes, which limits the duration of the discomfort. Patients experiencing high levels of anxiety can consult with the physician about a prescription for an anti-anxiety medication to be taken before the test.
Day-of Logistics and Procedural Expectations
On the day of the HSG, patients should wear comfortable, two-piece clothing, as they will need to undress from the waist down and change into a gown. Patients should arrive at the facility with identification, insurance cards, and a list of current medications. They must refrain from using vaginal douches, tampons, or medicated creams for at least 24 hours prior to the test.
Although most patients can drive themselves home, arranging for a partner or friend to provide transportation is advisable. This is relevant if an anti-anxiety medication has been taken, or if the patient is prone to dizziness or severe cramping. The procedure is performed on an X-ray table, similar to a standard gynecological exam, with the patient in a lithotomy position.
The physician first inserts a speculum to visualize the cervix, which is then cleaned with an antiseptic solution. A thin plastic tube, called a catheter or cannula, is guided through the cervical opening into the uterus. Once the catheter is in place, the contrast dye is slowly injected; this is when the patient typically experiences pressure or cramping. Fluoroscopic X-ray images are taken as the dye fills the uterine cavity and, if the tubes are open, spills into the abdominal cavity. The entire process, including preparation and imaging, usually takes about 30 minutes.
Post-Procedure Care and Safety Monitoring
Following the HSG, patients can typically resume their normal daily activities immediately. It is common to experience mild cramping, similar to a light period, and light vaginal spotting for up to a day or two afterward. Patients should expect a clear or sticky discharge, which is the contrast dye leaking from the cervix. It is recommended to wear a sanitary pad, not a tampon, to manage this discharge.
While the procedure is generally safe, patients must monitor for signs of potential infection or complication in the days following the test. Patients should contact their doctor immediately if they develop a fever of 100.4 degrees Fahrenheit or higher, experience severe abdominal pain that is escalating, have heavy vaginal bleeding, or notice a foul-smelling vaginal discharge. These symptoms may indicate a more serious issue, such as a pelvic infection, requiring prompt medical attention.