Skene gland cysts form when one or both of the small ducts that drain the Skene glands become blocked, trapping fluid and causing a sac to develop near the urethral opening. The exact trigger for that blockage is often unclear, but infection is the most commonly suspected cause in adults, while in newborns the cysts appear to develop before birth and may be linked to exposure to maternal hormones. Because these cysts sit so close to the urethra and vaginal opening, they can produce an unexpectedly broad range of symptoms, from chronic vulvar pain to urinary difficulties, and they are frequently mistaken for other conditions before the correct diagnosis is reached.
Where the Skene Glands Sit and What They Do
The Skene glands are a pair of tiny structures located on either side of the urethral opening. Their ducts empty just inside the urethral meatus, and they produce a small amount of fluid during sexual arousal. The glands were first described as the “female prostate” by the anatomist Regnier de Graaf in 1672. Alexander Skene drew wider attention to them in 1880, focusing on the two paraurethral ducts and their role in genital infections.1JNCI: Journal of the National Cancer Institute. The Female Prostate The name stuck, though the glands are still sometimes called paraurethral glands in clinical settings.
Modern research has confirmed that Skene gland tissue is structurally similar to male prostate tissue. Histological and immunohistochemical studies have demonstrated that these glands express prostate-specific antigen (PSA) and prostate-specific acid phosphatase, the same markers used to screen for prostate cancer in men.1JNCI: Journal of the National Cancer Institute. The Female Prostate Animal studies have reinforced the point, showing that the female prostate shares strong structural similarities with the ventral lobe of the male prostate.2PubMed. Female prostate: historical, developmental, and morphological perspectives This homology becomes clinically relevant when Skene gland cysts need to be distinguished from other periurethral masses, and it matters even more in the rare event of a Skene gland malignancy, where prostate cancer treatment strategies can sometimes be borrowed.
Why the Ducts Become Blocked
A Skene gland cyst develops when the duct that normally drains the gland’s secretions becomes obstructed. Fluid backs up behind the blockage, slowly stretching the duct or gland into a fluid-filled sac. In adults, the leading theory is that infection causes inflammation and swelling of the duct walls, which narrows or seals the opening. Sexually transmitted infections and urinary tract infections have both been proposed as triggers, though a clear infectious cause is not always identifiable in individual cases.3PubMed Central. Adult-onset Skene’s gland cyst following a history of multiple gynecological treatment interventions
Beyond infection, prior gynecological procedures and local trauma have been linked to cyst development. Scarring from surgeries, biopsies, or other interventions near the urethra can distort the tiny duct openings enough to prevent drainage. Still, many cases arise without an obvious cause. A cyst can grow silently for months or years before a person notices anything, and the fact that many women never develop one despite having the same gland anatomy suggests there may be individual anatomical or immune factors at play that are not yet well understood.
In newborns, the picture is different. Congenital Skene duct cysts are thought to develop in utero, possibly stimulated by maternal estrogen exposure during pregnancy.4PubMed Central. Paraurethral cysts in newborn girls These typically appear as small, round, yellowish interlabial masses noticed shortly after birth. They are rare, but they are one of the more common causes of a visible mass between the labia in a newborn girl.
What a Skene Gland Cyst Feels Like
Small cysts often produce no symptoms at all and may only be found incidentally during a routine pelvic exam. When a cyst grows large enough to press on the urethra or surrounding tissue, the symptoms tend to fall into two overlapping categories: vulvar discomfort and urinary trouble. Chronic vulvar pain and lower urinary tract symptoms are the most frequently reported complaints, and they can persist for months before the cyst is identified.5PubMed Central. Skene’s Gland Abscess: A Case Report and Narrative Review
Urinary symptoms can include a weak or deflected stream, a sense of incomplete emptying, difficulty starting urination, or frequent urinary tract infections. Some people describe a sensation of pressure or fullness near the urethral opening, or pain during intercourse. A larger cyst may be visible as a soft, round swelling at the front of the vaginal opening, sometimes mistaken for a prolapse or hernia. In one reported case, a woman with a Skene gland cyst was initially diagnosed with a scar hernia and then with nerve entrapment before the actual cyst was discovered during a physical examination, and surgical removal of the cyst resolved all of her symptoms.6BMJ Case Reports. Atypical presentation of Skene’s gland cyst
If the gland becomes infected, the cyst can develop into an abscess, which typically presents more acutely with redness, swelling, significant tenderness, and sometimes fever. The transition from painless cyst to painful abscess can happen suddenly, often prompting the first visit to a doctor.
Why These Cysts Are Often Misdiagnosed
One of the most frustrating aspects of Skene gland cysts is how frequently they are confused with other conditions. The region around the urethra can host several types of benign lesions, including urethral diverticula, urethral caruncles, urethral mucosal prolapse, Bartholin gland cysts, and Gartner duct cysts. All of these can produce similar symptoms such as bleeding, urinary changes, and vaginal discomfort, and distinguishing among them on physical examination alone can be difficult.7PubMed. British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions
The key anatomical clue for a Skene gland cyst is its location: it arises anterolateral to the urethral meatus, right where the Skene duct opens. A urethral diverticulum, by contrast, is an outpouching of the urethral wall itself and typically communicates with the urethral lumen, which is visible on contrast imaging. A Bartholin gland cyst sits much further back, near the posterior vaginal opening. Still, physical landmarks can be distorted by a large cyst, so imaging is often needed to tell these apart definitively.
How Imaging Pins Down the Diagnosis
A Skene gland cyst can sometimes be diagnosed on clinical grounds alone, especially when a smooth, non-tender swelling is visible right next to the urethral opening. When there is any doubt, imaging helps confirm the diagnosis and rule out conditions that would require different treatment.
Ultrasound, performed via a transperineal or transvaginal approach, is often the first imaging step. It can show the cyst as a fluid-filled structure and help determine whether it has any connection to the urethra.8PubMed. Imaging the Female Urethra: US and MRI in Cystic and Solid Pathologic Conditions MRI, however, has become the preferred tool when the picture is unclear, because its soft-tissue contrast is far superior. MRI can show whether the mass connects to the urethral lumen (suggesting a diverticulum rather than a cyst), map its exact relationship to the urethra and surrounding pelvic structures, and detect features that might suggest something more concerning than a simple cyst.9PubMed Central. Magnetic resonance imaging of paraurethral and paravaginal lesion: relevant diagnoses, key findings and surgical correlation
In one illustrative case, a woman’s periurethral mass was initially thought to be a possible diverticulum or fistula. Perineal ultrasound showed the mass did not connect to the urethra but was compressing it to one side. Contrast MRI then revealed a fluid collection below the pubic bone, consistent with a Skene gland cyst, and a separate cystogram confirmed no communication between the cyst and the urethral lumen, clinching the diagnosis.10PubMed Central. Complete excision of a Skene gland cyst mimicking cystocele That kind of multi-step workup is common when the cyst is large enough to distort normal anatomy.
Treatment When the Cyst Is Small or Not Causing Trouble
Not every Skene gland cyst needs to be treated. If a cyst is small, painless, and not interfering with urination or sexual function, watchful waiting is a reasonable first approach, particularly for older patients or anyone who prefers to avoid surgery. In newborns, expectant management is typically the default, since congenital paraurethral cysts frequently resolve on their own without any lasting effects.11PubMed. Congenital paraurethral cysts in two newborn girls: differential diagnosis, management strategies, and spontaneous resolution
If a cyst becomes infected and develops into an abscess, antibiotics are usually the first-line treatment. They can control the infection and reduce swelling, especially in smaller abscesses. However, antibiotics alone become less effective as the abscess grows, because the drug cannot easily penetrate a walled-off pocket of pus. When antibiotics fail or the abscess is large, a procedural step is needed to drain it.12PubMed Central. Skene’s glands abscess an overlooked diagnosis in acute lower urinary symptoms
Procedural and Surgical Options
Several procedures are available depending on the cyst’s size, whether it is infected, and whether it keeps coming back. The options range from a quick office procedure to a more involved operation under general anesthesia.
Needle Aspiration
For small, uncomplicated cysts, needle aspiration is the simplest intervention. A needle is inserted into the cyst to withdraw the fluid, collapsing the sac. This is particularly well documented in newborns: in a series of neonatal cases, needle aspiration alone produced excellent results with no recurrence, performing just as well as partial excision of the cyst wall.13Journal of Pediatric Surgery. Skene’s duct cysts in female newborns In adults, aspiration can provide quick relief, but recurrence is a concern because the gland lining remains intact and can refill.
Marsupialization
Marsupialization involves making an incision in the cyst wall and suturing the edges open so the cavity can drain continuously and gradually shrink. The idea is to create a permanent opening rather than just draining the contents once. This approach avoids the risks associated with dissecting the cyst away from the urethra and is considered an effective and streamlined technique for Skene gland cysts.14PubMed. Skene’s gland cyst: a simple marsupialization technique It is often a good middle ground between aspiration (which may not last) and full excision (which carries higher surgical risks).
Complete Surgical Excision
When a cyst keeps recurring or is very large, complete excision removes the entire cyst wall and gland tissue. The procedure typically includes cystoscopy to assess the urethra from the inside, careful dissection of the cyst wall from the urethral floor, full removal of the sac, and closure of the vaginal wall.15PubMed. Skene’s gland cyst excision Excision is considered the most definitive option but also carries the highest risk of complications because the cyst wall often sits intimately against the urethral tissue.
Laser Vaporization
A newer approach uses laser energy to vaporize the cyst lining rather than cutting it out. Compared to traditional excision, laser vaporization has shown some practical advantages: it tends to be shorter in duration, with intraoperative complications like bleeding and urethral injury occurring less frequently. Hospital stays have also been shorter after laser treatment.16Actas Urológicas Españolas (ScienceDirect). Outcomes of surgical treatment of large paraurethral cysts This option is not yet widely available at every center, but it is increasingly being studied as an alternative for larger cysts.
Risks and Complications of Surgery
The biggest concern with any procedure near the urethra is damaging it. Complete excision carries the risk of urethral injury, weakening of the small muscle fibers that help control urinary flow, urinary incontinence, urethrovaginal fistula (an abnormal connection between the urethra and vagina), and urethral stricture (scarring that narrows the urethra).17Journal of Pediatric Surgery Case Reports. Paraurethral Skene’s cyst case in puberty Stress urinary incontinence is perhaps the complication patients worry about most, and it has been reported after both marsupialization and total excision.18PubMed Central. Successful treatment of a complex Skene’s gland cyst: a case report
These complications are not common, but they are serious enough to influence treatment decisions. A surgeon will generally weigh the size and location of the cyst, the person’s symptoms, whether the cyst has recurred before, and the patient’s priorities around urinary continence before recommending excision over a less invasive approach.
Recurrence After Treatment
Recurrence is a real possibility regardless of which treatment is chosen. In the largest published series on surgical management of Skene gland infections and abscesses, about 88% of patients had resolution of symptoms after an initial excision. However, roughly 30% of those who initially improved went on to experience a recurrence that required further treatment. Among the patients who needed a second round of therapy, the success rate was again high, bringing the overall rate of complete symptom resolution to about 85%.19PubMed. Surgical management of Skene’s gland abscess/infection: a contemporary series
Those numbers mean that while most people do well in the long run, a meaningful fraction need more than one procedure. The patients most likely to have persistent trouble in that series were those whose primary complaint was urethral pain or recurrent urinary tract infections, rather than a clear-cut cyst or abscess. This suggests that when the underlying problem is more diffuse inflammation rather than a well-defined cyst, outcomes are less predictable.
Congenital Cysts in Newborns
When a baby girl is born with a small, round, yellowish or translucent mass between the labia, a Skene duct cyst is one of the main possibilities. These congenital cysts typically sit just beside the urethral opening, sometimes partially covering it. The fluid inside is often described as milky, and the mass displaces the urethral meatus slightly to one side, which helps distinguish it from other interlabial masses.20PubMed Central. Paraurethral Skene’s duct cyst in a newborn
The good news is that most congenital paraurethral cysts resolve on their own, typically within weeks. Two documented cases of newborn girls with clearly identified paraurethral cysts showed rapid, complete resolution without any surgical intervention, and neither baby had urinary problems.11PubMed. Congenital paraurethral cysts in two newborn girls: differential diagnosis, management strategies, and spontaneous resolution For this reason, the standard approach is to observe and wait. Intervention is reserved for the uncommon scenario where the cyst causes urinary obstruction. In those urgent cases, incision and drainage or needle aspiration provides immediate relief.4PubMed Central. Paraurethral cysts in newborn girls
When a “Cyst” Turns Out to Be Something Else
An extremely rare but important consideration is malignancy. Adenocarcinoma of the Skene gland is one of the rarest cancers in the female genital tract, accounting for less than 0.003% of all genital malignancies in women.21PubMed. Skene’s gland adenocarcinoma with increased serum level of prostate-specific antigen When it does occur, it can initially present as what appears to be a paraurethral mass, potentially mimicking a cyst. The tissue closely resembles male prostate cancer under the microscope, and it can even produce PSA. Serum PSA levels have been found to be elevated before surgical removal of a Skene gland tumor and to drop promptly afterward, suggesting that PSA monitoring could help track these tumors in a way similar to how it is used in men with prostate cancer.21PubMed. Skene’s gland adenocarcinoma with increased serum level of prostate-specific antigen
The connection to prostate cancer biology goes deeper than just histological resemblance. In one case, advanced imaging techniques developed for prostate cancer were applied to a Skene gland adenocarcinoma patient, and androgen deprivation therapy (a mainstay of prostate cancer treatment) had a measurable impact on PSA levels despite the patient being a postmenopausal woman with normal female testosterone levels.22PubMed. Skene’s Gland Adenocarcinoma: Borrowing From Prostate Cancer Experience for the Evaluation and Management of a Rare Malignancy In another case, a patient with stage pT3a disease was treated with robot-assisted surgery and remained in good condition four years later.23PubMed Central. Skene’s gland adenocarcinoma: a case report and review of the literature
None of this should cause alarm in someone with a simple Skene gland cyst. The overwhelming majority of paraurethral masses are benign. But it does explain why a doctor may want to send tissue for pathological examination after draining or excising a cyst, especially in older adults or when the mass has atypical features on imaging. The tissue homology between the Skene glands and the male prostate is not just an anatomical curiosity; it has practical implications for diagnosis and treatment in the exceedingly rare event that a malignancy arises.