Marsupialization of Skene’s Gland Cyst

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A 24 year-old woman presented to the Female Pelvic Medicine and Reconstructive Surgery clinic with a chief complaint of “a vaginal bulge”. In addition, she reported discomfort of during sexual intercourse, interrupted voiding and deviation of urinary stream. On examination, a 3x3 cm, cystic mass was observed to the left of the urethral meatus. No evidence of infection was noted and post void residual was 10cc. Diagnosis was cystic Skene’s gland. Initial conservative management and observation were not effective. The patient underwent marsupialization of the Skene gland cyst. This included a circular incision on the vaginal epithelium overlying the cystic gland which included both vaginal epithelium and underlying cystic wall.

Skene’s glands are bilateral and located at the bottom of the distal urethra. The glands help to lubricate the urethral meatus. Obstruction of the ducts leads to the formation of cyst. The cyst may present as a small, cystic mass, just lateral or inferolateral to the urethral meatus and it can become inflamed or infected. As Skene’s ducts are embryologically derived from the urogenital sinus, these cysts are lined by stratified squamous epithelium. 

Differential diagnoses of paraurethral cysts include urethral diverticulum (most common), vaginal cysts (Skene’s gland cyst), fibromuscular tissue, leiomyomata, ectopic ureteroceles, vaginal squamous cell carcinomas or infected granuloma. Skene’s gland cysts are differentiated from urethral diverticulum by location of the cyst: lateral location (skene’s gland cyst) vs suburethral location (diverticulum). When conservative managements are not effective, excision and marsupialization are the surgical options for Skene’s gland cyst. The reason why marsupialization was done for this case, instead of excision, was because the cyst was elongated along the urethra and the excision would have damaged the surrounding tissue if the cystectomy was performed. Marsupialization of Skene’s gland cyst can be a good surgical option with excellent clinical outcome.