Does an HSG Hurt? What Does It Mean if I Have Pain?

What You May Feel, How to Cope

Gynecologist Talking to a couple who are preparing for an HSG exam
Don't be afraid to ask your doctor questions about the test and what to expect. Fear can increase your perception of pain. Asking questions can help lessen your fears. Miodrag Gajic / E+ / Getty Images

Many women wonder if the hysterosalpingogram (HSG) test will cause pain. An HSG is an essential fertility test. It involves transferring an iodine dye via the cervix into the uterus and fallopian tubes. Then, the radiologist takes x-ray pictures. These pictures help your doctor evaluate your fallopian tubes and uterine shape.

So, will it hurt?

The truthful but somewhat annoying answer is- it depends.

Some women report mild-to-moderate cramping. Some don't feel much of anything. Very few report severe cramping.

Many say afterward that their fear of pain was much worse than any discomfort they felt.

What an HSG Feels Like

One thing it certainly feels like: awkward.

You’ll lie down on a table, usually with stirrups. But if they don't have stirrups, you might need to lie on the table, bend at your knees, with your feet flat (sort of) on the table, and hold your legs apart.

The technician, nurse, or doctor will insert a speculum into your vagina. This is the same metal device used during your yearly gynecological exam.

If you experience pain during your yearly visit, then this may be painful for you. (Women who suffer from sexual pain may also experience pain during gynecological exams.)

An x-ray machine will be lowered over your abdomen. This can be a bit awkward, especially with the speculum and your knees up.

Next, they will insert a swab to clean off the cervix. This is to reduce the risk of infection. If your cervix is sensitive to touch, this may be a bit achy. But most women don’t experience pain from this.

Next, they will insert a plastic catheter into the cervical opening. This feels kind of like a pap smear and might be a little uncomfortable.

Or you may not feel anything.

Finally, a special dye will be injected through the catheter. When the dye is injected, you may feel a warming sensation.

They will take the x-ray images. You might be asked to turn over on your side. (Yes, with the speculum in... like I said above, awkward.)

Then, the test is done. Everything is removed.

Why You Might Have Pain and What to Do if This Happens

Women who report severe pain during an HSG usually have one or both fallopian tubes blocked.

In most women, the dye just goes through the uterus, through the fallopian tubes, and out into the abdominal cavity. Usually painlessly.

However, if your tubes are blocked, the dye can cause pressure. This is what can then lead to strong discomfort or even pain.

During the test, if you feel pain, tell your doctor right away. Don’t just grin and bare it, or assume it’s normal. They can quickly remove the catheter, which will release the pressure, and should eliminate your pain.

The good news is that if you do feel strong pain, it shouldn't last for more than a minute.

Some women may have mild-to-moderate cramping for several hours after the procedure.

Your doctor may recommend over-the-counter pain medication for post-HSG cramping.

What You Can Do to Reduce HSG Pain

Most doctors recommend taking ibuprofen an hour before the HSG. This can reduce mild cramping during the test.

Anxiety and fear about the test can increase your perception of pain.

The test can be nerve-wracking, with this big x-ray machine hovering over you while you're lying on your back, legs apart, with the speculum inside. They may ask you to roll over to your side for an x-ray or two, and you have to do it with the speculum still between your legs.

It's normal to feel nervous. Deep, relaxed breathing through the procedure can help.

During my HSG, a nurse offered to hold my hand, and I took her up on the offer.

Don't be afraid to tell the nurse or doctor that you're nervous. They can offer reassurance, which really can help you feel better.

When Pain Is Not Normal

While mild cramps are normal, if the pain seems to be increasing after the test or you develop a fever, be sure to contact your doctor.

There is a rare risk of infection following an HSG. Increasing pain may hint to a brewing infection.

More about the HSG test:

More on fertility testing:


Hysterosalpingogram (HSG): Patient Fact Sheet. American Society of Reproductive Medicine.

Continue Reading