bartholin vs skene cyst
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Here is a detailed comparison of Bartholin vs Skene cysts:
Bartholin Cyst vs Skene (Paraurethral) Cyst
Gland Origin & Anatomy
| Feature | Bartholin Cyst | Skene Cyst |
|---|---|---|
| Gland | Bartholin (greater vestibular) gland | Skene (paraurethral / lesser vestibular) gland |
| Male homologue | Bulbourethral (Cowper's) gland | Prostate gland |
| Location | Posterior vestibule, posterolateral to the vaginal introitus | Adjacent to / just lateral to the urethral meatus |
| Clock position | 4-5 o'clock and 7-8 o'clock | Flanking the urethral meatus (anterior vulva) |
| Normal function | Secretes mucus for vaginal lubrication (starts at puberty, involutes with age) | Secretes fluid for vaginal lubrication |
Pathogenesis
Bartholin cyst: Obstruction of the Bartholin duct by an inflammatory process leads to accumulation of mucus - cysts are lined by transitional or squamous epithelium. Infection of the gland can produce acute adenitis and progress to a Bartholin abscess. - Robbins & Cotran Pathologic Basis of Disease
Skene cyst: Cystic dilation of the Skene gland duct, again typically from obstruction. Lined with transitional or stratified squamous epithelium. Not uncommonly noted in neonates and young to middle-aged women. Unlike urethral diverticulum (an important differential), Skene cysts do not communicate with the urethral lumen. - Campbell-Walsh-Wein Urology
Clinical Features
| Feature | Bartholin Cyst | Skene Cyst |
|---|---|---|
| Age group | Reproductive age (any age) | Neonates, young to middle-aged women |
| Size | Can reach 3-5 cm | Usually small, but can enlarge |
| Symptoms (cyst) | Often asymptomatic; pain and local discomfort when large | Often asymptomatic |
| If infected (abscess) | Rapidly enlarging, extremely painful, fluctuant mass at 4 or 8 o'clock position | Tender, inflamed; purulent fluid may be expressible from the ductular orifice |
| Urinary symptoms | Rare | Dysuria, urinary obstruction (if large enough to compress urethra) |
| Dyspareunia | Can occur | Can occur |
| Systemic symptoms | Fever/chills are uncommon | Rare |
Here is what a Skene gland cyst looks like clinically - note the translucent, rounded cystic structure near the urethra:
Skene gland cyst (Berek & Novak's Gynecology)
Microbiology (for abscesses)
- Bartholin abscess: E. coli is the most common isolate; many are polymicrobial. N. gonorrhoeae and C. trachomatis are less common but possible. - Tintinalli's Emergency Medicine
- Skene abscess: May involve similar organisms; N. gonorrhoeae can infect Skene glands in gonorrhea (alongside Bartholin gland involvement).
Key Differential Diagnoses
- Bartholin cyst must be distinguished from: labial abscess (requires gynecologic consult), Bartholin gland carcinoma (especially in women >40 - examine cyst wall for neoplastic epithelium)
- Skene cyst must be distinguished from: urethral diverticulum (UD communicates with the urethral lumen, is located mid-to-proximal urethra, does NOT distort the urethral meatus - Skene cysts are distal and distort the meatus), vaginal wall cysts, urethral prolapse
Management
| Treatment | Bartholin Cyst/Abscess | Skene Cyst/Abscess |
|---|---|---|
| Asymptomatic cyst | Observation | Observation |
| Abscess - first-line | Word catheter (stab incision, balloon inflated with 2-3 mL saline, left in place 4-6 weeks for epithelialization) | Incision and drainage, aspiration |
| Recurrent/large cyst | Marsupialization (incision on vaginal sidewall, suture cyst wall to vaginal mucosa with 4-0 Vicryl) | Marsupialization or surgical excision |
| Definitive | Excision (if marsupialization fails; send for histology if >40 yr) | Simple excision (curative) |
| Antibiotics | Broad-spectrum if abscess not yet walled-off | As needed for superinfection |
Quick Memory Hook
- Bartholin = Backside (posterior introitus), Big (up to 5 cm), Bulbourethral homologue - treat with Word catheter
- Skene = Surrounds urethra (anterior), Small but can obstruct, Simple excision is curative; homologue of the prostate
Sources: Robbins & Cotran Pathologic Basis of Disease; Tintinalli's Emergency Medicine; Berek & Novak's Gynecology; Campbell-Walsh-Wein Urology; Sabiston Textbook of Surgery; Pfenninger & Fowler's Procedures for Primary Care
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