What Is Pain-free HSG?

HSG is an examination method known and applied for more than 50 years. However, as a result of major advances in technology and new techniques developed in recent years examination times have decreased, adverse effects, and various complications such as pain and bleeding have completely disappeared or minimized.

In the old or standard technique, the use of some painkillers and muscle relaxants before starting the procedure is unfortunately not enough to eliminate the possibility of severe pain. To avoid the possibility of severe pain, anesthesia can be considered. However, anesthesia poses additional risks, and increases the cost of HSG and time spent for the examination.

"Pain-free HSG" does not mean HSG examination made under anesthesia. It is a radiologic examination of uterine by taking the advantage of state of the art technology of C-arm digital X-ray devices, utilizing new generation contrast agents having proper physical and chemical features, and choosing one of the thin, soft, custom-made (according to the form of uterine) cannulas that have been developed specifically for filling this agent into the uterine cavity.

On the other hand, the experience level of the team who will perform the HSG procedure is also a crucial factor. For example, if it is observed from the initial images that the tubes are blocked and will not be opened, applying contrast liquid at unnecessarily high pressures with the expectation that tubes may be clear, only leads the patient to suffer more pain. An experienced team knows how to approach each patient. They know how to deal with people who have panic attack, vaginismus history or various phobias. They decide with their knowledge and experience which catheter must be used in which patient, which pressure must be used or when the examination must be ended.

In a radiology centre, the following are necessary in order to get Painless HSG Uterine Imaging in an ideal way:

  1. C-arm medical imaging device (Due to fact that these machines are able to be at the opposite side of the uterus during examination no matter what the direction of uterus is, there is no need to push or pull the uterus by a hooked device. Moreover, by this machine it is possible to show some layered structures separately. Moreover, the new detector (flat panel detector) and tube technologies used together with advanced software controls minimize the radiation amount the patients and radiologists are exposed to.). (In our center, Siemens Artis zee model, the most advanced C-arm digital radiography system with flat panel detector is used.).
  2. Physicians and medical staff experienced in Painless HSG techniques. (Dr. Cevat Bayrak, who has developed and applied pain-free HSG techniques for more than ten years, is in charge of our center together with his experienced team.)
  3. New generation contrast agents (water-soluble, organic iodine, at proper viscosity and osmolarity, with appropriate physical features.)
  4. Various new generation, single use, special cannulas each developed to meet the requirements of different patients.

The following properties are expected in an ideal HSG film:

  1. Like a passport photograph, which must be in full-face view directly facing the camera, HSG images must be facing either front or rear side of uterus in full. Otherwise, it may not be possible to diagnose congenital anomalies of the uterus, or problems such as polyps, myoma or cohesion in the uterus.
  2. Papilla in tubes should be seen well and tube loops should be viewed from various angles if necessary in films.
  3. Examination should be short and painless without any bleeding.
  4. Occurrence of complications such as allergic reactions and infections should be minimum.
  5. Between the old and new generation devices or digital and analog devices, there are significant differences in terms of harmful radiation the patients are exposed. Patients cannot feel the radiation they are exposed to, but X-rays have harmful effects quietly on the tissues and cells. Results of these harmful effects may arise in the long term. The amount of radiation should be at the lowest level during an ideal HSG, and the amount of radiation the patient is exposed should preferably be stated to the patient in a separate report. (In our center, thanks to the devices and techniques used, radiation exposure is at a very low level, and the amount of radiation exposure can be reported for each patient).
  6. Price of HSG examination should be at a reasonable level.