Is the HSG test painful?
What is an HSG test?
The HSG is a fertility test used to check for blockages in fallopian tubes and abnormalities in the uterus. A quick canter through the procedure: A small tube is passed through the cervix into the uterus. A small balloon on the end of the tube is then inflated in order to anchor it in place. The x-ray dye is injected into the uterus, which (hopefully) passes through the fallopian tubes, whilst the radiologist takes x-rays to examine any blockages preventing the dye’s travel.
DISCLAIMER: Most women find the HSG painless, so please do not delay taking the test, spend the lead up in a fit of worry or cancel it, due to reading my experience below. You will probably not feel a thing. And even if you do, it is over within minutes and provides you with a life-long personal anecdote to overshare at the pub. My advice, pop some painkillers and spread your legs.
The HSG has a reputation in urban legend for being immensely painful. I hoped, dear reader, to write a reassuring report, to confirm that the horror stories were written by those with a penchant for hyperbole. But it is with a reluctant heart that I join the ranks of the whiners and wimps. In my experience the HSG can be described in one word: horrendous.
HSG is a bugger to book
Make clear this is for the NHS……. After slowly and carefully over pronouncing ‘hysterosalpingogram’ when booking the appointment with the hospital, I have since learnt that anyone who is anyone knows to call it the ‘HSG’. The NHS receptionist said ‘very good, you got it spot on!’, which made me feel like a vaguely competent foreign exchange student. She then told me, with unwarranted enthusiasm, that ‘there were no more slots left for this month’ and cheerfully suggested that I ‘try again next time!’.
Booking in for this test is a bugger. You have to call on the first day of your period to ensure that the test takes place between days 6 and 10 of your cycle. Day 5 or 11? No sir! The test cannot be undertaken when you are pregnant because it can cause serious damage to an embryo so I think that the strict requirements are based on the assumption that women are likely to have finished their period by day 6, but not yet have ovulated and had an egg fertilised by day 10, although that is just a guess. It took 4 months for me to get booked in and by the end I had mastered the process.
HSG booking: attempt No 3. Learning from my previous failed attempts at booking I wait until this morning to call the hospital, despite my period beginning yesterday afternoon. Its the medical version of Glastonbury tickets, if your not one of the first ones waiting when the lines open you miss out.
Top two tips for booking:
Call as soon as the lines open in the morning in order not to get pipped to the post by another (more efficient) infertile woman. This happened to me a couple of times: ‘Oh, sorry, our last appointment was snapped up an hour ago. Best of luck next month.’ If my period started during the day I would wait until the following morning to call.
It matters which day of the week your period starts. Because my hospital didn’t perform HSGs at the weekends, if day one of my cycle was a Thursday then there are only 3 days between days 6 and 10 of my cycle on which the HSG could take place. (Wednesday, Thursday and Friday the following week, as days 9 and 10 of the cycle fell on the weekend). If my period began on a Tuesday then there were 5 days and therefore more chance of getting an appointment. Playing the system was a naughty necessity. My period started on a Monday, but my desperation dictated that a Wednesday morning call was required to maximise my chances.
Is the HSG test painful? Nervous anticipation
My first nervousness about what was in store with the HSG (The HSG is a fertility test used to check for blockages in fallopian tubes and abnormalities in the uterus) was reading the NHS leaflet sent through the post, which described the procedure as causing 'various degrees of pain from barely any to very painful'. Medical staff always play down the pain caused, with an injection directly into a muscles being 'a small scratch' and a SMEAR test involving 'slight discomfort'. To see the NHS suggest that something may be 'very painful' brought me out in a cold sweat.
But it was a sliding scale of pain. Surely being a marathon runner and seasoned leg epilator would put me in a good position on the scale of pain thresholds? It would only be those weaklings that had never experienced childbirth or broken a bone who would suffer (oh wait, that's me too). Either way, the HSG was inevitable, so no point unduly worrying. Just wait for my period, book the test and crack on. Maybe it will provide me with the answers I so desperately need. Either way, the HSG was inevitable, so no point unduly worrying. Just wait for my period, book the test and crack on. Maybe it will provide me with the answers I so desperately need.
What is the HSG test like? Waiting without pants
I want to move in to the Royal Surrey Hospital. It’s cleaner than my house, with excellent amenities and readily available hot drinks. I weave through a huddle of red trousered gentlemen in reception (if playing Guess the Diagnosis I’d say gout or tennis elbow) and make my way to the radiology department. A nurse requested that I strip naked and put on two gowns, one to be worn backwards to ‘spare my dignity’. Ah bless. Given the number of fertility and SMEAR tests I’ve endured in pursuit of a pregnancy, I left my dignity back in 2014. Still, it prevented me from striding down a hospital corridor with my gown flapping in the wind and my arse hanging out, so I (and the other patients in the waiting area) should be thankful.
I am considering moving in my local Hospital. It is much cleaner than my house and has excellent amenities with a substantial M&S and Costa Coffee. I made my way to the radiology department where I had to strip naked and put on two gowns, one to be worn normally (with my bum hanging out) and the other to be worn backwards to 'spare my dignity'. Ah bless. Given the number of fertility and SMEAR tests endured since this process began, I had left my dignity back in 2014. Still, it prevented me from striding down a hospital corridor with my gown flapping in the wind and my arse hanging out, so I (and the other patients in the waiting area) should have been thankful.
I sat for half an hour with a plastic basket on my lap containing all my belongings, like a World War II child evacuee, whilst my husband read the hospital’s selection of well thumbed gardening magazines. To refer to my gown as ill-fitting would have been a complement. It was gaping. I wasn’t thinking about the procedure, or the potential pain. I was focused on one thought only: I’m sat in public without any pants. Only made worse by the disturbing sensation of a fresh breeze.
The HSG test - how is it done?
My first action was to sign a declaration that I was not pregnant. The doctor was highly apologetic, because it was a personal question or because it was an insensitive query for an infertile lady, I wasn’t sure.
There were two doctors carrying out the test, both absolutely lovely, like all NHS staff that I had encountered. One medic was operating the X-ray machine and the other inserting the instruments into my nether regions. Dr Nether Regions provided a running commentary of her actions, current and future. Despite being grateful that I was kept fully informed, it did feel like an unpleasant and painful medical safari.
It started the same way as a regular SMEAR test, with a speculum. But at the point the SMEAR test ended, the HSG test began. A quick canter through the procedure: A small tube is passed through the cervix into the uterus. A small balloon on the end of the tube is then inflated in order to anchor it in place. The x-ray dye is injected into the uterus, which (hopefully) passes through the fallopian tubes, whilst the radiologist takes x-rays to examine any blockages preventing the dye’s travel.
And so it began.
‘If I see any lesions then I’ll pop them as I go. Totally normal’.
‘Oh great! Thanks.’
I had no idea what lesions were and to pop them sounded like no big deal, the way that you ‘pop to the shops’ or ‘pop a cork’ from a bottle of champagne. It turns out that lesions are scar tissues that bind between two surfaces and ‘popping’ involves ramming through them with the small tube. I had 3 or 4 of these and it felt like a big deal.
The ballon being inflated at the end of the small tube was not ‘pressure’, as the doctor suggested, but intense and steady pain.
Then it happened, the dye. I wasn’t expecting it to be painful. My uterus doesn’t go in for the old cramping routine and I luckily never experience period pain. Blocked tubes, which can also cause the HSG to be more painful, were not an issue for me either. But when the dye was injected the pain rushed in. It was a burning sensation, like someone squirting hot oil onto my organs. After only 30 (very long) seconds I was teetering along the edge of my pain threshold, [normally gentle English woman. Someone cut in front of me and stole x, wouldn’t say anything for fear of hurting their feelings]. turning from a normally quiet and gentle women into a foul mouthed troll. Is pain induced Tourettes a thing? I hope so, as I blamed it during my subsequent apologies to the doctors for my terrible language.
Post procedure shell shock
After the test, I lay on the hospital bed in a shell shocked state with the doctor rubbing my legs to comfort me (thank goodness they were hair free). She told me not to move until the colour returned to my face (worrying), that ‘that was a bad one wasn’t it’ (yep) and that most people either have pain when the balloon inflates, or pain during the dye, but not both (lucky me).
With the NHS sanitary pad the size of a nappy between my legs (as orange coloured dye leaks out for a day or so) I hugged my basket of belongings to my chest and emerging like a World War II evacuee, I waddled out into the corridor. My husband, who was part way through an article on hydrangeas, took one look at my wide eyed and glazed stare, before quickly wrapping his arm around me and leading me out to safety. As advised by the doctors, I took the rest of the day off work, although honestly I would have been fine to go in. The only post op symptom was a slightly tender muff which prevented romantic activity for a couple of days.
Is the HSG pain like an early contraction in labour?
God I hope so, because if contractions are worse than that then I can declare, hands up, right now, that I cannot cope. In theory it could be similar as the cervix is slightly dilated, due to the inserted tube, and the uterus is repeatedly contracting, due to the dye. But an extensive internet search has not revealed an answer. Contractions during active labour must be more intense than an HSG, surely? But what about early contractions? The difference with labour is that you don;t have to remain completely still and endure it without pain relief. Oh, and that you are presented with your baby and not a plastic tray of your belongings.
The whole test, from start to finish, could not have taken more than 2 minutes. But I could not have endured a second more. Taking account of the NHS’ warning that the test could be ‘very painful’ for some, I should have anticipated being one of the unlucky few and taken over the counter pain relief before the test, just in case.
HSG test preparation. What I learnt from my HSG
The HSG was a life experience that I hope never to repeat, the sort that my mother would refer to as ‘character building’. My office love to undertake Lessons Learnt exercises, so here are the important life lessons I learnt from my HSG:
That my tubes are not blocked. The key learning, really, from this test.
That the preemptive taking of pain relief is to be encouraged, always
That if I am ever lucky enough to get pregnant, I am not going to cope well in labour
That I have pain related Tourettes, requiring me to take an ‘apology hamper’ for hospital staff if I ever go in to labour
That the NHS massively scrimp on the quality of their sanitary towels and have opted to buy a cheap job lot of adult nappies, and finally
That going commando in public is disconcerting, not sexy. Hospital corridors are breezy.
POSTSCRIPT: Is the HSG as painful as labour?
Since I wrote this post I have been lucky enough to experience labour and therefore have the answer to the world’s second most important question (after the meaning of life):
Early labour - Yes, the HSG was more painful than early contractions. During those contractions I could close my eyes, grit my teeth, attempt some hypno-birthing and breathe through it all with difficulty. The HSG ‘contractions’ were sharper and more shocking. Maybe because it was unexpected. Maybe because it was simply more painful.
Active labour - Nope. Dear God that hurts. It was different to the sharp burning sensation I felt with the HSG. Instead, active labour constituted intense internal cramps coupled with an overwhelming need to vomit. Unlike the drug-free HSG which demands a still patient to allow for clear x-rays, during labour you are allowed, even encouraged, to rock on all fours mooing like a cow whilst a medical professional administers the most amazing pain relief.
