Hysterosalpingography (HSG) is an X-ray procedure used to examine the internal structure of the uterus and the patency of the fallopian tubes. This diagnostic test is a standard part of a fertility workup, identifying anatomical issues that may prevent conception. The procedure involves injecting a contrast dye into the uterus and tubes, allowing them to be seen clearly on an X-ray screen. Because the test involves radiation and introducing material into the reproductive tract, specific preparation instructions, including restricting sexual intercourse, are necessary to safeguard the patient’s health and ensure accurate results.
The Risk of Conception During the Cycle
The primary reason for avoiding unprotected intercourse before an HSG is the risk of an undetected, very early pregnancy. The test is intentionally scheduled during the follicular phase, typically between cycle day 5 and day 12, after menstrual bleeding has stopped but before ovulation. This timing minimizes the possibility of a fertilized egg implanting in the uterine lining. If conception occurred just before the procedure, the developing embryo would be exposed to the contrast dye and X-ray radiation. Both the dye and radiation pose a risk of harm during the embryo’s sensitive stages of cellular division and development. Therefore, abstinence or the use of barrier contraception is required from the start of the menstrual period until the test is completed. This protocol ensures the procedure is not performed during a pregnancy, protecting the health of the potential embryo.
Protecting Against Pelvic Infection
Avoiding intercourse also minimizes the risk of introducing bacteria into the upper reproductive tract. The HSG procedure requires inserting a catheter through the cervix to deliver contrast dye into the uterine cavity. This process temporarily bypasses the cervix’s natural barrier function, creating a pathway into the uterus and fallopian tubes. Recent sexual activity increases the presence of bacteria near the cervix opening, raising the risk of infection during the procedure. If bacteria are pushed into the uterus or tubes along with the contrast dye, it can lead to Pelvic Inflammatory Disease (PID). Although the overall risk of infection is low, PID is a complication that can cause significant damage to the fallopian tubes. Minimizing potential sources of microbial introduction before the test is a simple measure to enhance patient safety.
Essential Steps for HSG Preparation
Several steps are necessary to ensure a smooth and comfortable HSG experience. Correct timing is necessary, with the procedure typically falling between Day 7 and Day 10 of the menstrual cycle, after flow has ceased. This timing ensures the uterine lining is thin. Pain management is recommended because the dye injection can cause uterine cramping. Taking an over-the-counter non-steroidal anti-inflammatory drug (NSAID) like ibuprofen about one hour before the test can reduce the severity of these cramps.
Practical Preparation Steps
Depending on individual risk factors, a healthcare provider may prescribe prophylactic antibiotics to be started before or after the procedure. Patients should also prepare for the following:
- Wear comfortable, dark-colored clothing, as there may be spotting or discharge of the contrast dye afterward.
- Bring a sanitary pad for immediate post-procedure use.
- Confirm all specific preparation instructions, including any fasting requirements or medication usage, with the medical facility performing the test.
Understanding the HSG Procedure
The HSG is an outpatient procedure that usually takes less than 30 minutes, with the imaging portion lasting only a few minutes. The patient is positioned on an X-ray table, similar to a standard gynecological examination. A speculum is inserted into the vagina to visualize the cervix, which is then cleaned with an antiseptic solution. A catheter is passed through the cervical opening into the uterine cavity. Once secured, the contrast dye is slowly injected into the uterus under continuous X-ray guidance (fluoroscopy). The dye fills the uterine cavity, outlines its shape, and flows into the fallopian tubes. The radiologist monitors the X-ray screen to observe if the dye spills freely into the pelvic cavity, indicating that the tubes are open.