It’s possible you’ve never heard of the Skene’s glands. Many people haven’t. Yet the Skene’s glands, which envelop the urethra and are often referred to as the “female prostate,” are responsible for female ejaculation – which may be an evolutionary defense mechanism to protect against UTIs.
When the Skene’s glands become infected or inflamed, this is a condition called skenitis. Skenitis can lead to urinary tract symptoms similar to those of a UTI as well as abscesses and cysts within the Skene’s glands. However, Skenitis often goes un- or misdiagnosed.
So how do you know if an infection in the Skene’s glands may be contributing to recurrent or chronic UTI symptoms? First, let’s cover the anatomy of these small but important glands.
- What Are The Skene’s Glands? >>>>
- Inflammation Of The Skene’s Glands >>>>
- Skenitis And Urethral Syndrome >>>>
- Skenitis And Vulvodynia >>>>
- Treatment Of Skenitis >>>>
What Are The Skene’s Glands?
The Skene’s glands, also known as the lesser vestibular glands or paraurethral/periurethral glands, are two glands, each approximately the size of a kernel of corn, with pinprick-sized openings.
Where Are The Skene’s Glands Located?
The Skene’s glands are adjacent to the urethra. They are collectively referred to as the female prostate because of their location relative to the urethra and secretion of female ejaculate.
The external openings of the Skene’s glands are present on either side of the lower end of the urethra within the vestibule. The vestibule is the triangle-shaped area between the labia minora and the clitoris. This region contains the urethral and vaginal openings.
Internally, the Skene’s glands hug the urethra much in the same way that the male prostate does. Female ejaculate is expelled through the openings of the Skene’s glands into the vestibule.
What Is The Function Of The Skene’s Glands?
Why are Skene’s glands part of female anatomy? One theory suggests that the glandular tissue and its capacity to release fluid develops in the embryonic stage before sex differentiation occurs.
Therefore, the female prostate may exist for the same reason as the male nipple: they simply grow before the embryo develops a specifically male or female reproductive system.
However, some scientists hypothesize that the evolutionary purpose of the Skene’s glands is to release female ejaculate, which lubricates the opening of the urethra. Female ejaculate contains antimicrobial substances that may help to prevent UTIs.
Given that sexual activity can be a trigger for UTIs, some researchers posit that female ejaculate may be part of the body’s natural defense system in this regard.
In fact, the Skene’s glands may play a critical evolutionary role. According to this theory, women who are less likely to experience a UTI after sex are more likely to have frequent sex, meaning they are more likely to get pregnant and therefore pass on their genes.
What Is Known About Female Ejaculate
Female ejaculate is a teaspoon amount of liquid that may be released before, during, or after an orgasm that usually involves G-spot stimulation. Female ejaculate resembles watery skim-milk, has a sugary flavour, and is dissimilar to urine in both smell and taste.
Chemically, female ejaculate contains high amounts of prostatic acid, phosphatase, prostatic-specific antigen (PSA), glucose, and fructose, and low amounts of urea and creatinine.
In other words, the presence of all of these fancy chemicals means it is similar to male ejaculate, save for the sperm. Female ejaculate was celebrated in many ancient cultures and was written about by both Aristotle and Galen.
Contrary to popular belief, female ejaculate and “squirting” are not the same thing. Squirting refers to the sudden and often robust release of clear fluid, generally during G-spot stimulation, that is frequently portrayed in adult films.
While mystery surrounded this fluid for some time, research has determined that squirting does in fact contain urine, along with small amounts of prostatic secretions.
In one study on squirting, female subjects first urinated and then took an ultrasound to determine that their bladders were empty.
Next, the subjects experienced sexual stimulation until they felt that they were on the verge of squirting. At this point, they underwent a second ultrasound, which indicated that their bladders had suddenly filled.
The subjects then continued with sexual stimulation until they squirted. Finally, they received a third ultrasound, which demonstrated that their bladders had once again been emptied.
It should be noted that while female ejaculation and/or squirting does exist, some people experience one or both, while others do not. These bodily reactions are not suggestive of the personal experience of stimulation or orgasm. Furthermore, approximately one third of people with female anatomy lack Skene’s glands entirely.
Skenitis: Inflammation Of The Skene’s Glands
“Skenitis” refers to inflammation of the Skene’s glands wherein they become swollen and sore. This inflammation is generally caused by infection linked to bacteria like gonorrhea, E. coli, vaginal flora, and various coliform bacteria. Gonorrhea is particularly notorious for causing skenitis.
Skenitis can occur alongside a UTI, making treatment for UTI more difficult. We’ll cover more on Skene’s glands and recurrent UTI in a bit.
Recurrent skenitis can lead to an abscess, which is a buildup of pus within the gland. The presence of an abscess can be confirmed through medical examination and imaging such as an MRI or transperineal sonography.
Complications Of Skenitis
If untreated, the pressure from an abscess may rupture the tissue, separating the Skene’s gland from the urethra, and cause a urethral diverticulum. A urethral diverticulum is a pocket that develops anywhere along the urethra and repeatedly fills with urine. In this case, that pocket is the Skene’s gland itself.
Alternatively, the pus from an abscess may harden into a cyst, which feels like a small pearl and contains a milk-like substance. Cysts can be removed surgically. Abscesses of the Skene’s glands are most common among people in their 30s and 40s and can be triggered by diabetes, pregnancy, physical trauma to the area, and a history of a skin condition called impetigo.
Skenitis can also be caused by vaginal or vulvar masses that create Skene’s gland lesions. In general, such masses are surgically removed.
Like the male prostate, the Skene’s glands can develop adenomas, which are benign glandular tumours, or adenocarcinomas, which are malignant glandular tumours. However, cancer of the Skene’s glands is less common than that of the prostate.
Symptoms Of Skenitis
As with many urogenital conditions, the symptoms of skenitis can overlap with other diagnoses, including urinary tract infection, vaginal infection, and endometriosis. So it’s important to bear in mind that experiencing any of the following symptoms does not necessarily point to an issue with the Skene’s glands:
- Recurrent urinary tract infection
- Suprapubic pain (pain near or behind the pubic bone)
- Dysuria (pain while urinating)
- Urethral pain
- White particles or mucus in the urine
- Difficulty urinating
- Vaginal discharge
- Pus leaking from the Skene’s gland/s (not female ejaculate)
- Dyspareunia (pain during or after intercourse)
- Localized tenderness around the Skene’s gland/s
- A small lump that can be felt with the fingertips (this could either be a Skene’s gland cyst or, if it is in a different area, a genital mass)
If the urinary stream consistently veers in the same direction or if urination is difficult, there is a possibility that there is a cyst in the Skene’s gland that is pressing on and perhaps even blocking the urethra.
Can Skenitis Cause Recurrent UTIs?
Skenitis and UTIs are a two-way street in that the infection from one can easily spread to the other, given the close proximity of the Skene’s glands to the urethral opening. After all, bacteria does not necessarily stay where it originated, especially in the urogenital region.
It’s possible that an infection in the Skene’s glands may act as a reservoir of bacteria that is somewhat protected during UTI treatment. Once the UTI treatment has ended, bacteria may seed into the urinary tract from the Skene’s glands, starting the cycle all over again.
Complicating things even further, a number of the symptoms of skenitis and UTI are fairly interchangeable, save for the possible lump of a cyst or the weeping of an abscess, as even the acute tenderness could be mistaken for urethral irritation.
As a result, skenitis is often misdiagnosed as a UTI or fails to be diagnosed alongside recurrent UTI. Because some UTI antibiotics may successfully treat skenitis without it ever being correctly identified, some researchers now believe that skenitis is actually far more common than previously thought.
What Organisms Cause Skenitis?
Many different organisms may be capable of infecting the Skene’s glands. As previously mentioned, skenitis is often caused by one of the following organisms:
- Gonorrhea, which is a sexually transmitted infection that typically first presents in the vagina
- E. coli, which lives in the gut and feces of healthy people and animals but which can migrate to the urinary tract and cause infection
- Vaginal flora, which describes organisms that exist in the vagina
It should be noted that the bacteria causing skenitis may appear in a urine culture if the sample includes the very beginning of the urine stream. UTI testing guidelines generally require a midstream urine sample, so this initial urine is typically missed.
The logic behind the midstream collection is that the sample is less likely to be contaminated by bacteria living on the skin, as this is immediately washed away when urination starts. In the case of skenitis, this is likely to also flush away the evidence.
Skenitis And Urethral Syndrome
Urethral syndrome, or urethral stenosis, refers to a collection of symptoms wherein no specific cause (e.g. bacterial infection) can be determined. Although skenitis is the most literal female equivalent to prostatitis, as previously discussed it is rarely diagnosed.
Therefore, urethral syndrome is often informally considered to be the female equivalent of male prostatitis due to the similar symptoms, even though anatomically they are not parallel.
Interestingly, approximately half of men experience prostatitis in their lives, and antibiotic treatment is only successful in 35% of chronic prostatitis cases.
This means that urinary symptoms such as frequency, urgency, pain during urination, and associated pelvic and lower back pain greatly affect both males and females but may have different causes.
Urethral syndrome and interstitial cystitis are both diagnoses of exclusion. A diagnosis of exclusion is given when a specific group of symptoms is present but the underlying cause is unknown, and the typical factors have been ruled out.
Urethral syndrome and interstitial cystitis share many of the same symptoms, with the only clinical difference being cystitis (inflammation of the bladder).
Symptoms of urethral syndrome include:
- Nocturia (frequent urination specifically at night)
- Frequency (frequent urination at any time)
- Urgency (the often sudden and sometimes overwhelming need to urinate, even if there is very little or no urine in your bladder)
- Urgency incontinence (wherein the need to urinate is so pressing that you are unable to make it to the toilet before a small or large amount of urine leaks out)
- Dysuria (pain during urination)
- Lower back pain, lower abdominal pain, and/or genital pain
- Dyspareunia (pain during or after intercourse)
- Microscopic hematuria (an extremely tiny amount of blood in your urine)
- Terminal or initial hematuria (the appearance of blood exclusively at the end or the beginning of your urinary stream)
- Post-void dribble (wherein a small amount of urine leaks out after you have finished urinating)
- Hesitancy (difficulty initiating urination)
- The sensation of being unable to fully empty your bladder
- Interrupted flow (wherein your urinary stream starts and stops multiple times in a manner that is beyond your control)
Is Urethral Syndrome Caused By Infection?
You’ll notice that many of the above symptoms are also associated with recurrent urinary tract infection (rUTI) as well as being described in the symptoms that make up interstitial cystitis (IC).
As mentioned earlier, the one symptom missing from the urethral syndrome list that does appear for both rUTI and IC is cystitis, or bladder inflammation.
Because cystitis is not associated with urethral syndrome, some researchers argue that the vast majority of urethral syndrome cases are in fact skenitis cases.
However, because doctors typically do not conduct a physical exam of the Skene’s glands via the vagina, the characteristic acute tenderness and possible infection-related mucus are often missed.
If you have been diagnosed with urethral syndrome or have frequent urethral symptoms, it may be worthwhile to ask your doctor to do a manual exam for skenitis.
Because skenitis and rUTI are not the only contributors to lower urinary tract symptoms, we’ve also covered 5 of the most common causes, alongside some of the lesser known possibilities.
It should be noted that one cause of nonbacterial urethral syndrome may be an allergy-like reaction presenting as inflammation in the urethral region. In this situation, people may find relief with a restricted diet (generally eliminating caffeine, alcohol, and spicy foods) and antihistamines.
Skenitis And Vulvodynia
Skenitis may also act as a trigger for vulvodynia. Vulvodynia refers to pain or discomfort and sometimes inflammation of the vulva (the external genitalia surrounding the vagina) that lasts longer than three months.
Like interstitial cystitis and urethral syndrome, vulvodynia is a diagnosis of exclusion. According to some research, 16% of women experience vulvodynia.
Symptoms of vulvodynia include feelings of stinging, burning, itching, stabbing, irritation, or rawness and can present in any vulvar region. These symptoms can, but do not necessarily, occur as a response to touch (such as during intercourse or when using a tampon).
Some who experience vulvodynia are exclusively symptomatic at certain times, such as right before menstruation or following intercourse, whereas others are symptomatic regardless of external factors.
Additionally, the individual experience of vulvodynia in terms of symptoms, frequency, intensity, and episodic occurrence may fluctuate.
As with chronic urinary symptoms, vulvodynia can have a dramatic impact on mood and stress level, concept of self, sexual enjoyment and conduct, romantic relationships, ability to partake in various physical or social activities, and overall quality of life.
Vulvodynia and interstitial cystitis are often comorbid (occur together), with studies indicating that approximately one quarter of people with interstitial cystitis also have vulvodynia.
Even without an official diagnosis of a urinary tract disorder, many of those with vulvodynia experience urinary tract symptoms such as bladder pressure or pain, frequency, and urgency. Furthermore, those who experience dysuria (painful urination) are more likely to develop vulvodynia than those who do not.
What Causes Vulvodynia, And How Is Interstitial Cystitis Involved?
Vulvodynia and interstitial cystitis (IC) are thought to share certain etiologic elements (causes). Firstly, overactive mast cells are often present in both conditions. Mast cells are white blood cells that are the body’s “first responders” against infection, and they trigger inflammation.
In addition to being implicated in chronic conditions such as Crohn’s disease and multiple sclerosis, mast cells are responsible for allergic reactions. Mast cells release histamine, which has been found to increase pain sensitivity in people with vulvodynia.
At present, little is understood about the potential involvement of overactive mast cells in vulvodynia and bladder conditions.
Secondly, both vulvodynia and IC (and potentially urethral syndrome) are activated by neuropathic pain, wherein the nerves serving the area fire at a lower threshold than normal.
This faulty nerve behaviour can be, but is not necessarily, the lasting result of a localized (and “healed”) injury or infection like skenitis, and may be aggravated by inflammation. In female anatomy, the reproductive and urinary system share many of the same neural pathways.
Finally, both vulvodynia and IC symptoms can be affected by hormonal fluctuations, such as those right before menstruation.
More research is needed on the possible link between vulvodynia, IC, and skenitis. However, it stands to reason that these conditions could potentially be connected in multiple ways.
As mentioned, vulvodynia is sometimes triggered by an infection that results in nerve misbehaviour. Not only that, but the acute tenderness and inflammation of skenitis could theoretically be mistaken for vulvodynia.
If you receive a vulvodynia diagnosis but believe you may have skenitis, a conversation with your medical practitioner may be helpful.
How Skenitis Is Diagnosed
A thorough pelvic exam includes palpitation (massaging) of the anterior (front) vaginal wall where the Skene’s glands are located. This exam could result in the discovery of skenitis, as discharge may emerge from the abscess or a cyst may be felt.
However, if your doctor believes you have a UTI, you may not receive a pelvic exam and instead may only be asked to provide a urine sample.
While there is a chance of bacteria from infected Skene’s glands making it into the sample cup, urine tests are not a reliable method of detecting skenitis, and there is no standard test for the bacterial load in female ejaculate.
If you think you may have skenitis, you might like to talk to your doctor or a urologist or urogynecologist who has experience treating skenitis and ask them to specifically examine your Skene’s glands.
Treatment Of Skenitis
As previously discussed, some cases of bacterial skenitis may be misdiagnosed as urinary tract infection and respond positively to the prescribed oral antibiotics.
However, for an antibiotic to be effective on a bacterial infection within the Skene’s glands, it must be able to penetrate the tissue. For this reason, a number of antibiotics that are prescribed for UTIs will not successfully treat skenitis as they do not penetrate the glandular tissue but are instead active only in the urine.
Treatment for skenitis also typically requires a longer antibiotic course than that prescribed for an uncomplicated UTI – generally four to six weeks. This antibiotic treatment methodology is more comparable to antibiotic treatment for prostatitis than for UTI.
Symptom management for acute skenitis includes warm, moist compresses and sitz baths.
Skene’s Gland Cyst Treatment
A Skene’s gland cyst or abscess is typically treated with oral antibiotics. If it does not respond, then surgical intervention may be required.
The abscess can be surgically drained either via needle aspiration or via a small incision created at the gland opening, possibly with the edges cauterized to allow for continuous seepage. This procedure is typically performed using topical anesthetic.
If Skene’s gland abscesses or cysts are recurrent, it can increase the risk of a malignant tumor, and so removal of the Skene’s gland may be considered.
Finding The Right Support For Urethral Symptoms
Skenitis, like any urinary tract issue, can have a dramatic impact on mental well-being. In addition to the acute pain and discomfort of the physical symptoms, it can lead to depression and anxiety; impact your self-confidence; limit the activities you feel comfortable or confident taking part in physically or socially; and affect your sexual enjoyment and, by proxy, your romantic relationships.
If you are struggling with the emotional toll of chronic or recurrent skenitis, you may want to reach out to a health psychologist. A good place to start is our video interview series with Dr. Sula Windgassen, a health psychologist with her own chronic UTI experience.
You may also find it helpful to join a Facebook support group, such as the Bartholin and Skene Gland Cyst Support Group. You can request insights from others who have dealt with skenitis to learn how to find a specialist who may be able to help.
Additionally, surgeons who contribute to research studies often treat patients directly. So browsing research articles on the topic of skenitis may be another approach you use to find answers. Of course, you are always welcome to share your story with us by commenting below!
To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page.