Skenes Gland Cyst: Symptoms, Types, Causes and Treatment

Skene’s gland cysts are an uncommon but important condition affecting women’s urogenital health. Despite their rarity, understanding their symptoms, types, causes, and treatments is essential for accurate diagnosis and management. This comprehensive article synthesizes current research to help patients and clinicians recognize and address Skene’s gland cysts effectively.

Symptoms of Skenes Gland Cyst

Skene’s gland cysts can range from completely asymptomatic to causing significant discomfort and urogenital symptoms. Recognizing these symptoms is the first step toward timely diagnosis and management.

Commonality	Symptom	Clinical Note	Source(s)
Frequent	Vaginal mass	Bulging near anterior vaginal wall, suburethral	1 3 8
Moderate	Dyspareunia	Pain during intercourse	1
Moderate	Urinary tract infection	Recurrent or persistent UTIs	1
Occasional	Voiding dysfunction	Difficulty urinating, altered stream	1 6
Occasional	Asymptomatic	Detected incidentally during routine exam	6 8

Table 1: Key Symptoms

Understanding the Symptoms

Skene’s gland cysts commonly present as a vaginal mass, often described as a bulge in the anterior vaginal wall, sometimes visible near the external urinary meatus. This can alarm patients, but the cyst is often benign in nature 1 3 8.

Dyspareunia and Discomfort

• Dyspareunia (painful intercourse) is a frequent complaint among affected women. The mass may cause discomfort during penetration, impacting sexual health and quality of life 1.
• Some women report a persistent sensation of fullness or pressure in the vaginal area.

Urinary Symptoms

• Recurrent urinary tract infections (UTIs) are another hallmark. The cyst may harbor bacteria or impede normal urine flow, facilitating infection 1.
• Voiding dysfunction, such as difficulty initiating urination or changes in urinary stream, can also occur if the cyst exerts pressure on the urethra 1 6.

Asymptomatic Cases

• In a significant number of cases, Skene’s gland cysts may be asymptomatic and discovered incidentally during pelvic examinations or imaging for other reasons 6 8.

Symptom Progression

• Infection: Symptoms may worsen if the cyst becomes infected, leading to increased pain, redness, or even abscess formation 3 8.
• Absence of Symptoms: Many cysts remain symptomless until they enlarge or become infected, at which point more overt symptoms manifest 8.

Types of Skenes Gland Cyst

Skene’s gland cysts are not uniform. They vary in location, size, and underlying pathology, sometimes mimicking other periurethral masses.

Type/Class	Description	Distinctive Feature	Source(s)
Simple cyst	Fluid-filled, benign, often asymptomatic	Teardrop-shaped, close to urethra	3 8
Infected cyst	Cyst complicated by infection	Thickened wall, possible gas inside cyst	3
Diverticulum	Urethral diverticula connected to Skene’s gland	Horseshoe or spoke-wheel shape on imaging	3
Malignant tumor	Rare, neoplastic transformation (e.g., carcinoma)	Cystic-solid mass, rapid growth	2 3
Mimickers	Masses mistaken for cyst (e.g., leiomyoma)	Pathology differs on histology	4

Table 2: Types of Skene’s Gland Cyst and Related Lesions

Breaking Down the Types

Simple Skene’s Gland Cyst

• Most common form. Presents as a fluid-filled sac near the distal urethra.
• Imaging: Teardrop-shaped lesion adjacent to the urethra, hypo-intense on T1-weighted MRI and hyper-intense on T2 3 8.
• Symptoms: Often asymptomatic or causes mild symptoms.

Infected Skene’s Gland Cyst

• Complication: Infection may lead to cyst wall thickening, internal gas, and enhancement on imaging 3.
• Symptoms: Increased pain, erythema, systemic signs if severe.

Urethral Diverticulum Involving Skene’s Gland

• Distinct entity: A diverticulum is an outpouching of the urethral wall that may communicate with Skene’s gland.
• Imaging: Horseshoe or spoke-wheel appearance, often surrounding the urethra 3.
• Symptoms: May mimic or overlap with cysts but can have more complicated presentations.

Malignant Tumors

• Rare: Very few cases of primary carcinoma (adenoid cystic carcinoma, adenocarcinoma, neuroendocrine carcinoma) have been reported 2 3.
• Appearance: Cystic-solid mass; rapid growth; may have perineural invasion (spread along nerves) in malignancy 2.

Mimickers

• Leiomyoma and others: Sometimes, masses thought to be Skene’s gland cysts are different benign tumors like leiomyomas or cysts from other glands (e.g., Gartner’s duct cyst) 4 8.

Causes of Skenes Gland Cyst

Understanding what leads to Skene’s gland cyst formation is crucial for prevention and management. Causes are multifactorial, involving anatomical, infectious, and sometimes neoplastic processes.

Cause	Mechanism/Pathway	Notable Features	Source(s)
Ductal blockage	Obstruction of Skene’s gland duct	Most common cause	8
Infection	Ascending bacterial invasion	May cause or complicate cyst	3 8
Congenital	Developmental anomalies in duct/gland	Rare, may present in youth	8
Trauma	Injury to periurethral area	May lead to secondary cyst	1 6
Neoplasia	Malignant transformation	Exceptionally rare	2 3

Table 3: Causes of Skene’s Gland Cyst

Delving into the Causes

Ductal Obstruction

• Primary cause: Most Skene’s gland cysts form when the gland’s duct becomes blocked, leading to accumulation of glandular secretions and gradual enlargement of the cyst 8.
• Etiology: Blockage can result from inflammation, scarring, or local trauma.

Infection

• Secondary infection: Bacterial infection can either trigger the formation of a cyst (by causing inflammation and blockage) or complicate an existing cyst 3 8.
• Common pathogens: Similar to those found in urinary tract infections, often ascending from the urethra.

Congenital Factors

• Rare: Some cysts may arise from congenital anomalies in the development of the Skene’s gland or its duct, presenting early in life 8.

Trauma

• Iatrogenic or accidental: Procedures (such as catheterization) or local injury may damage the periurethral glands, predisposing to cyst formation 1 6.

Neoplastic Transformation

• Exceptionally rare: In rare cases, a neoplasm (benign or malignant) can develop within Skene’s gland, masquerading as a cyst 2 3 4.

Treatment of Skenes Gland Cyst

Management of Skene’s gland cysts centers on symptom relief, exclusion of malignancy, and prevention of recurrence. Treatment is tailored to the patient’s symptoms, cyst size, infection status, and underlying pathology.

Approach	Indication	Key Point	Source(s)
Observation	Asymptomatic, small cysts	Regular follow-up	7
Surgical excision	Symptomatic, large, recurrent cysts	Complete removal, low recurrence	1 6 8
Marsupialization	Distal/accessible cysts	Efficient, preserves tissue	5 7
Drainage	Temporary relief, not definitive	Recurrence likely	7
Antibiotics	Infected cysts	Adjunct to surgery if infected	3 8
Imaging	Preoperative mapping, exclude malignancy	Ultrasound, MRI for planning	3 7

Table 4: Treatment Options for Skene’s Gland Cyst

Exploring Treatment Options

Conservative Management

• When to observe: Asymptomatic and small cysts may not require immediate intervention. Regular monitoring is vital to detect any changes or onset of symptoms 7.

Surgical Excision

• Gold standard: For symptomatic or complicated cysts, complete surgical removal is preferred. This has a high success rate, low recurrence, and preserves urethral and sexual function 1 6 8.
• Techniques: Surgical excision involves careful dissection to remove the cyst wall and close the vaginal wall, sometimes accompanied by procedures like distal meatoplasty for associated urethral issues 1.

Marsupialization

• Minimally invasive: Marsupialization is effective for distal cysts. The procedure involves creating a permanent opening to the cyst, allowing continuous drainage and preventing recurrence 5 7.
• Benefits: Preserves tissue, quick recovery, and low risk of recurrence.

Simple Drainage

• Not recommended as sole therapy: While it may provide temporary relief, simple aspiration or drainage often leads to recurrence and does not address the underlying ductal issue 7.

Management of Infection

• Antibiotic therapy: If infection is present, antibiotics are administered, sometimes prior to surgery to reduce the risk of postoperative complications 3 8.

Imaging and Preoperative Planning

• Role of imaging: Ultrasound, MRI, and CT are used to characterize the cyst, rule out malignancy or diverticulum, and guide surgical planning 3 7.
• Differential diagnosis: Imaging helps distinguish Skene’s gland cysts from other periurethral or vaginal masses, avoiding misdiagnosis 3 4.

Prognosis

• Excellent outcomes: Surgical treatments are highly effective, with very low rates of recurrence and minimal complications when performed by experienced clinicians 1 6 8.
• Sexual function preserved: Most women remain sexually active post-surgery with no significant change in function 1.

Conclusion

Skene’s gland cysts, though rare, can cause a spectrum of symptoms affecting urinary, sexual, and overall quality of life. Timely recognition and appropriate management are essential for optimal outcomes.

Key Points Covered:

• Skene’s gland cysts most commonly present as a vaginal mass with potential urinary or sexual symptoms, but many remain asymptomatic 1 3 8.
• There are several types, including simple cysts, infected cysts, diverticula, rare malignancies, and mimickers such as leiomyoma 2 3 4.
• Causes range from ductal obstruction and infection to rare congenital or neoplastic factors 8 3.
• Treatment centers on observation for asymptomatic cases, surgical excision or marsupialization for symptomatic cysts, and antibiotics for infection. Imaging is key to diagnosis and surgical planning 1 3 5 6 7 8.

By staying informed about the nuances of Skene’s gland cysts—symptoms, types, causes, and treatments—patients and clinicians can work together for prompt diagnosis and effective care.