Introduction
Skenitis is the infection of the Skene’s glands. Skene’s glands are the paraurethral glands located at the upper wall of the vagina. The infection process obstructs the paraurethral ducts. The symptoms are benign and represent an abnormality in the urethral diverticula. The skenitis infection is diagnosed based on the history and physical examination, but some cases present with non-palpable lesions and require further imaging.
What Is a Skene Gland?
Skene’s glands are the lesser vestibular glands on either side of the urethra. They secrete a substance to lubricate the urethral opening. The excreted substance is known to be antimicrobial and is used to prevent urinary tract infections. Its function is not fully known, but it is believed to be the source of response to sexual stimulation. Skene’s glands are also the periurethral glands.
What Is Skenitis?
Skenitis is a disease of Skene’s glands and develops from the infection caused by N.Gonorrhea, which is confused for urinary tract infection (UTI). Any infection or inflammation of the Skene’s gland affects the urethra, obstructing the paraurethral ducts. The Skene’s gland becomes enlarged and tender when infected, and recurrent infections lead to obstruction of the gland and result in a suburethral cyst or an abscess cavity. Large cysts may cause urethral obstruction and urinary retention.
What Are the Symptoms of Skenitis?
The symptoms of skenitis include:
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Chronic urethral pain.
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Recurrent urinary tract infections.
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Dyspareunia (painful sexual intercourse).
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Dysuria (painful urination).
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Vaginal pain.
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Feeling the urge to urinate.
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Swollen Skene’s glands.
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Vaginal discharge.
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Abdominal pain.
What Are the Causes of Skenitis?
The common causes of skenitis can be bacterial infections and urinary tract infections. The causative organisms are bacteria such as gonorrhea, E.coli, and Chlamydia trachomatis. Other causes include the following:
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Cysts or abscesses of the Skene’s gland or urethra.
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Certain cancers.
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Sexually transmitted diseases.
What Is Skene Gland Cyst?
A Skene’s gland cyst is a cyst that usually occurs at the urethral opening, is generally filled with fluids or pus, is rare, and needs to differentiate from the urethral diverticulum. They may or may not show symptoms but have a history of gynecological treatment interventions. The symptoms include a painful, fluctuant, erythematous mass inferolateral to the urethra, accompanied by urinary tract infections, painful urination (dysuria), pain during sexual intercourse (dyspareunia), and obstructive dysfunction. These cysts can be seen in newborns as a congenital anomaly resulting from cystic degeneration of embryonic remnants of the paraurethral glands. In adults, the cause is unknown, but any obstruction to the duct due to infection can lead to a cyst formation. Treatment of cysts includes surgical interventions like needle aspiration, marsupialization, and partial or total excision of cysts with good outcomes.
How to Differentiate Skenitis From UTI (Urinary Tract Infection)?
UTI is most common in women and includes symptoms such as increased urination, painful urination, and cloudy and foul-smelling urine. UTI is a bacterial infection that can be treated with antibiotics. UTI is diagnosed with a urine sample.
Skenitis is an infection of Skene’s glands that are present in the urethral and is most commonly caused by gonorrhea or UTI. Its symptoms are the same as UTI, pelvic pain, and dyspareunia. Skenitis is diagnosed using the imaging tests such as MRI, CT scan, or ultrasound scan of Skene’s glands, and surgical management may be required in case of a cyst and abscess formation.
How to Diagnose Skenitis?
Diagnosis of skenitis is based on the history and physical examination of the patient. It includes the following steps:
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Clinical Evaluation – In this, the anterior vaginal wall and area of the urethra are palpated and inspected to check for any nodules, masses, or points of tenderness. Palpation of the bladder is essential to elicit bladder tenderness.
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Ultrasound evaluation with urinary tract infection symptoms helps detection of a paraurethral fluid mass; homogeneous in cysts or non-homogeneous in case of an abscess is considered for diagnosis.
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Magnetic resonance imaging (MRI) shows high specificity. The Skene’s gland duct cysts are seen as round or oval hypertense lesions lateral to the external urethral meatus.
When to Seek Medical Help for Skenitis?
One can seek medical help immediately as they experience the symptoms such as:
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Urinary retention.
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Blood in the urine.
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Increased urination.
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Abnormal vaginal discharge.
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Pain during sexual intercourse.
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Inability to hold urine.
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Cloudy, foul-smelling urine.
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Burning or painful urination.
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Abnormal pressure along the pubic bone.
What Is the Treatment and Management of Skenitis?
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A surgical incision and cyst drainage in case of abscess and infection.
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Marsupialization is a surgical procedure carried out for recurrent cyst cases to remove the cyst and drain the abscess. It is a streamlined and effective approach for Skene’s gland cysts and infections.
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Antibiotic treatment includes Cefixime, Ofloxacin, Ciprofloxacin, Doxycycline, and Azithromycin.
What Happens if Skenitis Is Not Treated?
If skenitis is left untreated, it can lead to extremely rare cancers. Urethral adenosquamous carcinoma of the Skene’s gland results due to untreated skenitis with symptoms such as vaginal bleeding and a mass followed by involvement of multiple lymph nodes and valvular metastasis. The patient may also present with a history of symptoms like dysuria, hematuria, and periurethral lesion.
Immunohistochemical features determine the carcinoma revealing intestinal differentiation. Magnetic resonance imaging (MRI) shows a mass and swelling of inguinal lymph nodes present at the anterior wall of the vagina surrounding the urethra, forming a cyst or tumor. The treatment involves a multidisciplinary action, including surgical tumor removal and chemotherapy.
Conclusion
Skene’s glands are paraurethral glands present on either side of the urethra. Skenitis is the Skene’s gland infection, most commonly caused by gonorrhea and UTI. The symptoms include dysuria, UTI, dyspareunia, abdominal pain, swollen gland, and chronic urethral pain. The skenitis is diagnosed by imaging tests and treated using marsupialization. If left untreated, it leads to cancers and is very rare (0.02 percent).
