Skene’s gland revisited: function, dysfunction and the G spot

Abstract

Despite Skene’s gland being described over 300 years ago, and the frequent performance of surgery on and around these glands, it is remarkable how little we know about what they do and potential problems associated with them. Infection in these glands was described with gonorrhoeal infection in 1672 by Regnier de Graaf (1641–1693), which was long before Skene [1] described them in 1880. Controversy exists on the function of Skene’s glands, their role in sexual function, female orgasm and ejaculation, and even their anatomy. What is their role in the causation of urogynecological symptoms such as urethral pain and sexual dysfunction? Urogynaecological surgery in this area is commonplace for the treatment of urethral or paraurethral pathology, urinary incontinence or vaginal prolapse. What effect can this have on their function and sexual function more generally? In a histopathological study Wernert et al. [2] described Skene’s gland as a group of glands arranged in long ductal structures situated in the caudal two thirds of the urethra “mainly in the dorsal and lateral mucosal stroma but extending in some cases to the smooth musculature of the septum urethrovaginale”. These glands are not always present and were found in only two thirds of the 33 women they studied. They are “tubuloaveolar formations on long ductal structures” and resemble male prostate glands prior to puberty and androgenic stimulation. They contain prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) on immunostaining [2]. A more recent study [3] has confirmed the presence of prostate-specific antigen reactivity in the paraurethral tissues and in the “superficial layer of the female secretory (luminal) cells of the female prostatic glands and membranes of secretory and basal cells and membranes of cells of pseudostratified columnar epithelium of the ducts”. These ductal structures run longitudinally around the distal urethra located on the anterior vaginal wall. The literature is unclear on whether the glands open through a single or multiple orifices either into the distal urethra (similar to the male prostate) or a single duct orifice onto the left and right sides of the external urethral orifice. However it is my experience in asymptomatic women (Fig. 1) or where there is infection and abscess formation (Fig. 2), there is a single duct external to the urethral meatus. The distal urethra and vagina have an intimate relationship with the clitoris, both anatomically and functionally. The clitoris consists of an exterior glans, a midline densely neural nonerectile structure that is continuous with the erectile tissue of the paired bulbs and crura, which surround the distal urethra and vagina. The distal urethra, vagina and clitoris have a shared vasculature and nerve supply (the dorsal nerve to the clitoris) and form a tissue cluster described by O’Connell et al. [4] as the “locus of female sexual function and orgasm”. These tissues around the distal urethra become engorged with sexual arousal, but there is debate whether secretions are produced during coitus by Skene’s gland, or if ejaculation with orgasm occurs, similar to the male prostate. Heath [5] proposed that a large amount of lubricating fluid can be secreted from this gland similar to a “female ejaculation" when stimulated from inside the vagina and to such an extent that it can be mistaken for urine and coital urinary incontinence. If this does occur, it is an uncommon cause Related articles can be found at doi:10.1007/s00192-011-1461-9 and doi:10.1007/s00192-011-1488-y.