How Do You Select The Right Speculum Version For HSG Procedures?

Selecting the right speculum for an HSG procedure comes down to one primary factor: access. Hysterosalpingography requires catheter placement through the cervical canal, which means you need a speculum that stabilizes the cervix, gives you room to maneuver instruments, and allows you to retract the speculum without disturbing what you have already placed. For most HSG procedures, an open-sided speculum is the recommended choice precisely because it addresses all three of these requirements.

Using the wrong speculum for HSG is slowing down your procedures

When you use a standard speculum for an HSG, you run into a practical problem the moment the catheter is in place: removing the speculum without dislodging the catheter becomes unnecessarily difficult. This adds procedural time, increases patient discomfort, and raises the risk of having to reposition instruments. The fix is straightforward: matching the speculum type to the procedure from the start eliminates this friction entirely. An open-sided design solves the retraction problem structurally, without requiring extra technique or workarounds.

Poor cervical visibility during HSG is increasing your risk of misdiagnosis

HSG depends on clear visualization of the cervix to guide catheter placement accurately. If your speculum is limiting light reflection, compressing tissue in a way that distorts the view, or simply not holding the cervix in a stable position, you are working with incomplete visual information. The consequence is not just a longer procedure but a higher chance of misplacement or missed findings. Choosing a speculum with a white surface, rounded cervix-supporting edges, and a stable bill design directly addresses this. Better light reflection and cervical positioning give you a cleaner, more reliable view from the start.

What is an HSG procedure and why does speculum choice matter?

An HSG, or hysterosalpingography, is a fluoroscopic imaging procedure used to examine the uterine cavity and fallopian tubes. A contrast medium is injected through a catheter placed in the cervical canal, and X-ray imaging captures the fill pattern. Speculum choice matters because the speculum must keep the cervix accessible and stable while allowing catheter placement and, ideally, retraction without disturbing the catheter.

Unlike a routine cervical screening, where the speculum stays in place throughout a brief examination, HSG involves active instrument manipulation and often requires the speculum to be removed after catheter placement while the catheter remains engaged. A standard speculum design does not accommodate this well. The closed-bill structure makes retraction around an in-place catheter awkward and risks pulling the catheter out of position.

Beyond access, the speculum also affects how clearly you can visualize the cervix during catheter placement. Poor visibility at this stage increases the chance of misplacement, which extends procedure time and adds to patient discomfort. Speculum selection is therefore not a minor detail in HSG. It directly affects procedural efficiency, patient experience, and the reliability of catheter placement.

What are the different speculum versions available for HSG?

For HSG procedures, the two most relevant speculum versions are the standard speculum and the open-sided speculum. The standard version suits routine examinations, while the open-sided version is specifically designed for procedures like HSG that require catheter placement, lateral access, or speculum retraction while instruments remain engaged with the cervix.

A well-designed speculum range for gynecological use typically includes four versions:

Standard speculum: Suited for routine examinations, cervical screenings, and procedures that do not require lateral access or instrument retraction
Open-sided speculum: Designed for procedures like HSG, hysteroscopy, HyFoSy, and IUD insertion, where catheters or instruments need to remain in place during or after retraction
Smoke extraction (SX) speculum: Optimized for electrosurgical procedures where surgical smoke needs to be evacuated without obstructing the field of view
Open-sided SX speculum: Combines the lateral access of the open-sided design with the smoke evacuation channel, suited for ablation procedures

For HSG specifically, the open-sided version is the standard recommendation. It provides the access geometry that HSG requires, and its robust hinge and bill design maintains a stable, spacious opening even under procedural load.

Why is an open-sided speculum recommended for HSG procedures?

An open-sided speculum is recommended for HSG because it allows the speculum to be retracted while leaving the catheter engaged with the cervix. The open side also provides greater vertical and horizontal access compared to a standard speculum, making catheter insertion and adjustment significantly easier without requiring repeated repositioning.

The core challenge in HSG is that once the catheter is placed and the contrast medium is being injected, the speculum often needs to be removed to allow fluoroscopic imaging without obstruction. With a standard closed-bill speculum, this retraction either risks pulling the catheter out of position or requires a second pair of hands to stabilize everything. An open-sided speculum eliminates this problem structurally. The catheter can stay exactly where it is while the speculum is withdrawn around it.

Beyond retraction, the open-sided design also provides more generous access during the placement phase. The larger opening, both vertically and horizontally, gives you more room to guide the catheter into the cervical canal accurately, especially in cases where cervical positioning is not straightforward. For procedures like HSG, HyFoSy, and THL that share this access requirement, the open-sided speculum is consistently the more practical choice.

How does speculum size affect HSG procedure outcomes?

Speculum size affects how well the cervix is exposed and stabilized during HSG. A speculum that is too small may not provide adequate exposure, making catheter placement harder. One that is too large increases patient discomfort and tissue pressure unnecessarily. Matching the size to the patient’s anatomy improves both access and comfort during the procedure.

For the open-sided speculum used in HSG, size selection follows the same principles as standard speculum selection. In clinical practice across Western Europe, medium-sized specula cover the majority of procedures, with wide sizes needed for a smaller proportion of patients. The key is that the chosen size should expose the cervix clearly without excessive lateral pressure on the vaginal walls.

In the context of HSG specifically, getting the size right also affects how smoothly the speculum can be retracted once the catheter is in place. A well-fitted speculum retracts cleanly. One that is too wide or positioned under significant tissue tension is harder to withdraw without disturbing the catheter. Sizing is therefore not just about patient comfort; it has a direct effect on procedural flow.

What features should a speculum have for single-handed HSG operation?

For single-handed HSG operation, a speculum should offer a reliable locking mechanism that engages and releases without requiring two hands, a stable bill design that holds position under instrument load, and a handle angle that keeps your second hand free for catheter placement and adjustment throughout the procedure.

Single-handed operation is particularly valuable in HSG because catheter placement requires active hand control. If the speculum demands constant manual stabilization or needs two hands to lock and unlock, you lose the ability to manage the catheter and the speculum simultaneously. A speculum with a single-handed locking mechanism frees your other hand for instrument work from the moment you open the bills to the moment you retract.

The handle angle also matters more than it might appear. A backward-angled handle reduces contact with the patient’s body during manipulation and allows for deeper, more controlled insertion without needing to switch to a longer speculum size. This is a practical advantage in HSG, where catheter placement demands precise positional control and any unnecessary adjustment to the speculum disrupts workflow.

Silent operation is another feature worth considering. Click-free locking mechanisms eliminate the sounds that cause patients to tense up involuntarily. Tension increases resistance, which makes cervical access harder and increases the chance of patient discomfort. A speculum that operates quietly contributes to a more relaxed patient, and a relaxed patient makes the procedure easier to perform.

How do you choose between a clear and white speculum for HSG visibility?

For most HSG procedures, a white speculum provides better visibility because its surface reflects and distributes external light toward the cervix more effectively than a clear speculum. A clear speculum can distort the view due to tissue compression and discoloration through the plastic. White is the preferred choice when accurate cervical visualization is the priority.

The visibility difference between white and clear specula is not cosmetic. When light passes through a clear plastic bill, it interacts with compressed vaginal tissue in a way that can alter the appearance of what you are seeing. Tissue discoloration and local compression under the bill can make it harder to assess the cervix accurately. A white surface, by contrast, reflects external light forward and into the cavity, improving illumination without requiring an internal light source.

Clear specula do have a specific use case: situations where you need to inspect sutures, assess bleeding patterns, or evaluate conditions where seeing through the bill itself adds diagnostic value. For HSG, where the goal is to position a catheter accurately and confirm cervical access, white is the more practical choice. The improved light reflection supports clearer visualization of the cervical os, which is exactly what catheter placement depends on.

How Bridea Medical helps with HSG speculum selection

We design our speculum versions specifically around the procedural demands gynecologists face, and HSG is one of the procedures that shaped the development of our open-sided range. The Orchid Spec Open-Sided is built to address the exact access and retraction challenges that make HSG procedurally demanding.

Here is what the Orchid Spec Open-Sided brings to HSG procedures:

Catheter-friendly retraction: The open side allows you to withdraw the speculum while leaving catheters or instruments engaged with the cervix
Single-handed locking: Silent, click-free locking frees your second hand for instrument control throughout the procedure
Robust bill design: The hinge and bill maintain a stable, spacious opening under procedural load without caving or shifting
White surface for visibility: Superior light reflection toward the cervix without needing an internal light source

Our specula are made in the Netherlands, tested and certified by the NHS Surgical Materials Testing Laboratory, and used in 90% of Dutch hospitals. If you want to see how the Orchid Spec Open-Sided performs for HSG and other access-dependent procedures, explore the full Orchid Spec range or contact us directly to request a product demonstration.