Skene duct cysts develop adjacent to the distal urethra, sometimes causing perineal discharge, dyspareunia, or abscess formation.
Skene glands (periurethral or paraurethral glands) are located adjacent to the distal urethra.
Vulvar Anatomy
At the center of this image is the vagina, a canal composed of smooth muscle. The small opening directly above it is the urethra, which is the opening from the bladder. Below the vagina is the anus. Above the urethra is the clitoris, a body of erectile tissue that is homologous to the penis. The vagina is surrounded by the labia minora, which are surrounded by the labia majora. The pubic bone is at top. The purple tissue is a continuation of the clitoris, the crus of clitoris. The bulb of the vestibule (blue) also consists of erectile tissue. Below the bulb is a Bartholin gland, which secretes mucus to lubricate the vagina. BO VEISLAND/SCIENCE PHOTO LIBRARY |
Skene duct cysts form if the duct is obstructed, usually because the gland is infected. They occur mainly in adults.
Cysts may become infected, leading to recurrent urinary tract infections (UTIs) and abscesses. Rarely, Skene duct cysts (if large enough) obstruct the urethra.
Most Skene duct cysts are < 1 cm and asymptomatic. Some are larger and cause dyspareunia. The first symptoms may be similar to those of UTIs (eg, dysuria). Abscesses are painful, swollen, tender, and erythematous but usually do not cause fever.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Diagnosis of Skene Duct Cyst
Pelvic examination
Diagnosis of Skene duct cysts is usually clinical. Most symptomatic cysts and abscesses are palpable adjacent to the distal urethra; however, a diverticulum of the distal urethra may be clinically indistinguishable, requiring ultrasonography or cystoscopy for differentiation.
Treatment of Skene Duct Cyst
Surgical excision or marsupialization if the cyst causes symptoms
Symptomatic cysts are excised or marsupialized (the everted edges of the cyst are sutured to the exterior).
Key Points
Skene duct cysts form if the duct is obstructed, usually because the gland is infected.
Cysts may form abscesses and/or cause recurrent UTIs.
Most are small and asymptomatic; large cysts may cause dyspareunia.
Diagnose Skene duct cysts by pelvic examination and, if needed, by ultrasonography or cystoscopy.
Excise or marsupialize symptomatic cysts, and treat abscesses with broad-spectrum antibiotics and excision or marsupialization.
