A Skene gland cyst, sometimes called a paraurethral cyst, forms when one of the Skene glands — located on either side of the urethral meatus at the anterior vestibule — becomes blocked and fills with retained secretions. The Skene glands are considered the female homologue of the prostate, sharing embryologic and histologic features with prostatic tissue and expressing prostate-specific antigen (PSA). These cysts are uncommon and can closely mimic other periurethral masses, making accurate imaging essential for correct diagnosis and surgical planning.
Skene gland cysts are one of three principal glandular cysts of the lower female genital tract, and their periurethral location distinguishes them from the anterolateral vaginal Gartner's duct cysts and the posterolateral introital Bartholin gland cysts. The most critical differential diagnosis for a Skene gland cyst is urethral diverticulum — a pouch communicating directly with the urethral lumen — because the two can be indistinguishable on physical examination yet require entirely different surgical approaches. MRI is the only imaging study that reliably makes this distinction, establishing whether the periurethral mass communicates with the urethra or is separate from it.
Causes
Duct obstruction.
Skene gland cysts arise from obstruction of the small ducts that carry glandular secretions from the Skene glands to their openings on either side of the external urethral meatus. When these ducts are blocked, secretions accumulate and progressively distend the duct and gland into a palpable periurethral cyst. The Skene glands develop from the urogenital sinus under androgenic influence and are histologically similar to the male prostate — they express PSA and prostatic acid phosphatase (PAP), and their secretions are thought to contribute to female ejaculation. Their ducts are small and susceptible to obstruction from minor trauma, inflammation, or scarring.
Other contributing factors.
Prior infection — particularly with Neisseria gonorrhoeae or Chlamydia trachomatis — is a well-recognized cause of Skene duct obstruction through scarring of the duct orifice. Vaginal delivery and perineal trauma can damage the delicate duct openings and predispose to obstruction. Chronic inflammation from recurrent vulvovaginal infections, lichen sclerosus, or prior perineal surgery also contribute. A Skene gland abscess forms when the cyst contents become bacterially superinfected, producing a tender, fluctuant, erythematous periurethral mass that can be mistaken for a urethral caruncle or Bartholin abscess. Unlike Gartner's duct cysts, Skene gland cysts are not associated with congenital urinary tract anomalies.
Symptoms
Small Skene gland cysts are often asymptomatic and are found incidentally during pelvic examination or during pelvic MRI performed for other indications. As the cyst enlarges, it produces a visible or palpable smooth, round mass at the anterior vestibule immediately adjacent to the urethral opening. Urinary symptoms are common and are caused by mechanical compression of the urethra — including a weak or deviated urinary stream, urinary frequency, urgency, incomplete bladder emptying, and recurrent urinary tract infections from urinary stasis. Pain with intercourse (dyspareunia) and a sensation of perineal fullness or pressure are additional complaints. A Skene gland abscess presents with acute-onset severe perineal pain, significant swelling and erythema at the urethral meatus, and sometimes fever — a presentation that can easily be misdiagnosed as a urethral caruncle or distal urethral pathology without imaging.
Diagnosis
Physical examination identifies a smooth, soft to firm periurethral mass at the anterior vaginal wall adjacent to the meatus. Gentle compression of the mass may express a small amount of mucoid fluid from the Skene duct orifices, which is pathognomonic when present. Urinalysis and urine culture evaluate for concurrent urinary tract infection. However, physical examination alone cannot reliably distinguish a Skene gland cyst from a urethral diverticulum — the single most important differential diagnosis — or from other periurethral cystic conditions.
An MRI of the pelvis with dedicated high-resolution sequences of the urethra and periurethral tissues is the definitive imaging study. MRI demonstrates the Skene gland cyst as a well-defined, T2-hyperintense, non-communicating cystic structure at the anterolateral periurethral location — crucially distinct from a urethral diverticulum, which communicates with the urethral lumen and often wraps around it in a characteristic horseshoe or circumferential pattern on axial imaging. This communication vs. non-communication is the critical MRI finding that separates these two conditions and dictates completely different surgical approaches: a Skene cyst is excised as a discrete structure, while a urethral diverticulum requires urethral diverticulectomy with careful closure of the urethral defect. MRI also distinguishes a Skene gland cyst from Bartholin cysts (posterolateral at the introitus), Gartner's duct cysts (anterolateral vaginal wall, extending superiorly), vaginal inclusion cysts, and rare solid paraurethral tumors. Atypical signal characteristics — solid components, restricted diffusion on DWI, or enhancing nodules — warrant biopsy to exclude the rare Skene gland carcinoma.
Classification
Periurethral masses in women encompass several entities that require precise MRI characterization for management.
- Skene gland cyst: Well-defined, T2-hyperintense cyst adjacent to the urethral meatus without urethral lumen communication. Benign. Managed with observation if asymptomatic or surgical excision if symptomatic.
- Skene gland abscess: Infected Skene cyst producing acute severe periurethral pain, erythema, and swelling. Requires prompt incision and drainage. Antibiotics added for surrounding cellulitis or systemic infection.
- Urethral diverticulum: Outpouching of the urethral wall communicating with the urethral lumen — the most important differential to exclude on MRI. Requires urethral diverticulectomy with urethral closure, not simple cyst excision.
- Skene gland carcinoma: Extremely rare adenocarcinoma or transitional cell carcinoma arising within the Skene gland. Presents as a solid or complex periurethral mass, often with PSA elevation. Any atypical or solid periurethral mass, and any mass in a postmenopausal woman, warrants biopsy.
Treatments
Treatment is determined by symptom severity, abscess formation, and the presence of atypical features.
Observation: Small, asymptomatic Skene gland cysts discovered incidentally require no intervention. Warm sitz baths may provide comfort for minor symptoms. Serial pelvic examination or imaging confirms stability and excludes gradual enlargement or development of atypical features that would prompt reassessment.
Incision and drainage for abscess.
Acutely infected Skene gland abscesses require prompt incision and drainage — delay leads to progressive enlargement, severe pain, and risk of spontaneous rupture. A small catheter may be placed to maintain patency of the drainage site during healing, similar to Word catheter management of Bartholin abscesses. Antibiotics targeting the causative organisms — including gonorrhea and chlamydia coverage when STI is suspected — are added when cellulitis or systemic signs are present. Culture of expressed pus guides antibiotic selection.
Surgical excision.
Complete surgical excision is the definitive treatment for symptomatic, recurrent, or diagnostically uncertain Skene gland cysts. The procedure requires careful dissection immediately adjacent to the urethra — which lies just millimeters away — making preoperative MRI essential for understanding the precise anatomic relationship of the cyst to the urethral wall, the bladder neck, and surrounding neurovascular structures. A urethral catheter is placed before surgery to maintain urethral identification throughout the dissection and reduce the risk of inadvertent urethrotomy. Recurrence after complete excision is uncommon. When a urethral diverticulum has been identified on MRI rather than a Skene gland cyst, the surgical approach changes entirely — the urethral defect must be formally closed in layers over a catheter to restore urethral integrity.
Biopsy for atypical features.
Any periurethral mass with solid or complex features on MRI, any mass that recurs despite appropriate treatment, or any new periurethral mass in a postmenopausal woman should be biopsied to exclude Skene gland carcinoma and other rare paraurethral malignancies before surgical planning proceeds.
Get an MRI to Confirm Your Diagnosis
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