Cervical Stenosis – Hysterosalpingography
Cervical stenosis refers to partial or complete narrowing of the cervical canal, which may be congenital or acquired. Acquired causes include prior cervical surgery, radiotherapy, infection, postmenopausal atrophy, or scarring following instrumentation. On hysterosalpingography (HSG), cervical stenosis is suggested by difficulty in cannulation, delayed or minimal passage of contrast through the cervical canal, and poor or absent opacification of the uterine cavity (Fig. 1).
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| Fig-1 |
Findings: Contrast outlines a narrowed, elongated cervical canal with resistance to flow. Uterine cavity opacification is delayed or incomplete. Tubal assessment may be limited due to inadequate contrast passage.
Conclusion: Hysterosalpingographic findings are suggestive of cervical stenosis.
Patient Symptoms
Patients may present with infertility, dysmenorrhea, hypomenorrhea or amenorrhea, difficulty during cervical procedures, or cyclic pelvic pain due to obstructed menstrual outflow.
Procedure (Hysterosalpingography)
The examination is performed during the early proliferative phase of the menstrual cycle. Cannulation may be technically challenging, often requiring gentle cervical dilatation or the use of a fine balloon catheter. Contrast is injected slowly under fluoroscopic guidance.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. A small volume (3–6 mL) is injected slowly due to increased resistance at the cervix.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Uterine tenaculum
- Leech–Wilkinson cannula
- Rubin cannula
- Fine balloon HSG catheter
- Cervical dilators (if required)
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Excessive force during cannulation or contrast injection should be avoided to prevent cervical injury or uterine perforation. Pregnancy and active pelvic infection must be excluded prior to the procedure.
Related Conditions
Differential diagnoses include cervical atresia, severe intrauterine adhesions, and uterine hypoplasia. Hysteroscopy allows direct visualization and therapeutic dilatation when indicated.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.
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