Skene's duct cysts develop adjacent to the distal urethra, sometimes causing perineal discharge, dyspareunia, urinary obstruction, or abscess formation.

Skene's glands (periurethral or paraurethral glands) are located adjacent to the distal urethra. Cysts form if the duct is obstructed, usually because the gland is infected. They occur mainly in adults. Cysts may form abscesses or cause urethral obstruction and recurrent UTIs.

Most cysts are < 1 cm and asymptomatic. Some are larger and cause dyspareunia. The first symptoms may be those of urinary outflow obstruction (eg, hesitancy, dribbling, retention) or of UTIs. Abscesses are painful, swollen, tender, and erythematous but usually do not cause fever.

Diagnosis

• Clinical evaluation

Diagnosis 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

• Surgical excision if the cyst causes symptoms

Symptomatic cysts are excised. Abscesses are treated initially with oral broad-spectrum antibiotics (eg, cephalexin 500 mg q 6 h for 7 to 10 days) and are excised or marsupialized.

Last full review/revision December 2008 by S. Gene McNeeley, MD