A Skene gland cyst is a relatively uncommon, non-cancerous gynecological condition that can cause concern due to its location and symptoms. These cysts develop in a pair of glands that are a normal part of the female anatomy, but they can sometimes become a source of irritation or discomfort. This article provides clear insights into the origins, identification, and medical management of Skene gland cysts.
What Skene’s Glands Are and What They Do
Skene’s glands are a pair of small ducts located on either side of the urethra, often referred to as the paraurethral glands. They were named after the gynecologist Alexander Johnston Chalmers Skene, who described them in the late nineteenth century. These glands are considered homologous to the male prostate gland and are sometimes called the “female prostate” because they develop from the same embryonic tissues.
The primary function of Skene’s glands relates to both urinary and sexual health. They secrete a fluid that helps to lubricate the urethral opening, potentially protecting against the entry of bacteria. This fluid may also contain antimicrobial substances, which could play a role in preventing urinary tract infections.
During sexual arousal, the tissues surrounding the glands become engorged with blood, and the glands secrete a fluid that contributes to overall lubrication. The fluid produced by the glands is a milk-like substance that has been shown to contain proteins similar to those found in male ejaculate, such as prostate-specific antigen. This suggests the glands may be the source of what is sometimes referred to as female ejaculation during orgasm.
How Skene Gland Cysts Form
A Skene gland cyst begins to form when one of the gland’s small ducts becomes obstructed, preventing the flow of fluid out of the gland. Since the gland continues to produce its lubricating secretions, the trapped fluid begins to accumulate, causing the gland to swell and enlarge into a cystic structure. The size of these cysts can vary significantly, though most are typically less than one centimeter in diameter.
The blockage that initiates the cyst formation can be traced to various pathological processes affecting the surrounding tissue. One common cause is chronic inflammation or infection of the duct, known as skenitis. Bacterial infections, including those associated with sexually transmitted infections or recurrent urinary tract infections, can inflame the ductal opening, leading to scarring and closure.
Physical trauma or irritation to the area can also contribute to the obstruction of the delicate duct. Once the duct is fully blocked, the ongoing production of fluid within the gland exerts pressure, causing the thin walls of the gland to distend. This trapped fluid is what ultimately creates the benign, fluid-filled sac known as a Skene gland cyst. In rare cases, the cyst may be a congenital anomaly, resulting from the cystic degeneration of embryonic tissue remnants.
Identifying Symptoms and Diagnosis
Many Skene gland cysts are small and do not cause any noticeable symptoms, often going undetected unless they are found incidentally during a routine pelvic examination. When symptoms do occur, they typically relate to the physical presence of the mass or its secondary effects on urinary function. A person may notice a soft, movable swelling or lump near the urethral opening on one side.
Larger cysts can lead to discomfort, particularly during activities that put pressure on the area, such as sexual intercourse or prolonged sitting. If the cyst is positioned in a way that compresses the urethra, it may cause symptoms like difficulty starting a urine stream, a feeling of incomplete bladder emptying, or even urinary retention. The partial obstruction of the urethra can also predispose the person to recurrent urinary tract infections.
Diagnosis usually begins with a thorough physical and pelvic examination, during which the physician can visually inspect and palpate the area around the urethra. To confirm the diagnosis and rule out other conditions that can present similarly, such as a urethral diverticulum or a Gartner cyst, imaging studies may be used. A transvaginal ultrasound can provide a clear view of the fluid-filled structure, and sometimes a cystoscopy, which involves inserting a flexible viewing tube into the urethra, is performed to visualize the cyst’s relationship to the urinary tract.
Treatment and Management Strategies
The approach to managing a Skene gland cyst depends heavily on its size and whether it is causing symptoms. Small cysts that are asymptomatic often require only a period of watchful waiting, as some may resolve spontaneously without intervention. If a cyst becomes infected, forming an abscess, the initial treatment involves a course of antibiotics to clear the infection before any surgical procedure is considered.
For cysts that are large, painful, or causing significant urinary symptoms, surgical intervention is generally recommended. One common surgical technique is marsupialization, which is designed to prevent recurrence. In this procedure, the surgeon makes a small incision into the cyst and then stitches the edges of the cyst wall to the surrounding vulvar skin. This creates a permanent, open pouch that allows the fluid to drain freely, effectively eliminating the closed cavity where fluid could re-accumulate.
Another definitive treatment option is complete surgical excision, which involves removing the entire cyst and the affected glandular tissue. Excision may be preferred in cases where marsupialization has failed or for cysts that are particularly large and complex. A less invasive option for temporary relief is therapeutic fine-needle aspiration, where a small needle is used to drain the fluid, though this method carries a higher risk of the cyst recurring because the gland lining remains intact.