EpistemisInflamed Skene's gland cyst
Specialty: Gynecology and breast.
Why it occurs
- Mechanical obstruction of the excretory duct of the paraurethral glands of Skene with accumulation of mucoid secretion
- Concomitant lower urinary tract infection with direct bacterial invasion of the glands
- Sexually transmitted infection due to Neisseria gonorrhoeae or Chlamydia trachomatis
- Urethral trauma during vigorous intercourse or previous bladder catheterization
Initial workup
Detailed inspection of the introitus and external urinary meatus (a fluctuating and painful mass is observed on palpation on the anterior wall of the vagina, just below the urethra). Sampling of purulent secretion or urethral mucus using smears for common microbiological culture and multiplex PCR for STIs (gonococcus, chlamydia). Transvaginal or focused urethral ultrasound if there are diagnostic doubts with a urethral diverticulum.
red flags
Fever, acute urinary retention due to mechanical compression of the urethra by the giant inflamed cyst, discharge of massive purulent secretion through the external urinary meatus, intolerable perineal and urethral pain that prevents ambulation, progressive urethral perimeter induration.
Standard management
- Amoxicillin/clavulanic acid 875/125 mg orally every 8 hours for 7 days associated with Ibuprofen 400-600 mg every 8 hours
- Ceftriaxone 500 mg intramuscularly in a single dose if there is a strong clinical suspicion of gonococcal infection. If the cyst is abscessed and fluctuating, simple surgical incision and drainage or marsupialization of the gland is performed vaginally (note: it is essential to differentiate Skene's cyst from a urethral diverticulum to avoid sphincter injuries or accidental urethro-vaginal fistulas during drainage).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 4
- Treatment options
- 2