Introduction:

Skene’s gland abscesses are uncommon and underdiagnosed. The diagnosis is based on the clinical history and physical examination.

Case description:

This clinical case reports the follow-up of a 26-year-old woman who came to the primary care unit due to the appearance of a perineal mass, difficulty in initiating urination, and bladder repletion. During observation, a 2cm diameter mass, located in the anterior vaginal wall, involving the urinary meatus, afferent to the labia majora was observed. The hypothesis of uro-vaginal prolapse was considered and an ultrasound study was requested. Approximately one month later, the patient returned with intense perineal pain triggered by the introduction of the endovaginal ultrasound probe. On physical examination, she presented the same periurethral mass - now with clear local inflammatory signs and abundant purulent exudate exteriorised through the urethra. The ultrasound examination does not describe any relevant alterations. The most probable hypothesis was the formation of a Skene’s gland abscess. The patient was medicated then with azithromycin and cefuroxime, with the resolution of the condition.

Discussion:

Skene’s gland abscesses present as periurethral masses, associated with purulent urethral exudate, urethral pain, and/or urinary alterations. The symptoms’ evolution may be crucial to establish the diagnosis. Once the diagnosis is established, empirical antibiotic therapy is recommended, considering the most frequently implicated agents (Escherichia coli, Neisseria gonorrhoeae, and agents of the vaginal flora). Therefore, in the presence of a painful periurethral mass in female patients, the list of differential diagnoses should include the hypothesis of Skene’s gland abscess, so as not to lose the opportunity for early treatment.

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