How is excessive female ejaculate related to Skene's gland dysfunction managed?

Management of Excessive Female Ejaculate Related to Skene's Gland Dysfunction

The management of excessive female ejaculate due to Skene's gland dysfunction should focus on pelvic physical therapy as the first-line treatment, followed by consideration of pharmacological approaches if necessary. 1

Understanding Female Ejaculation and Skene's Gland Function

• Female ejaculation originates from the paraurethral (Skene's) glands, which are homologous to the male prostate 2
• True female ejaculation involves the secretion of a few milliliters of thick, milky fluid containing prostate-specific antigen (PSA) during orgasm 3
• This should be distinguished from "squirting," which is the expulsion of larger volumes of diluted urine, and from coital incontinence 3
• Skene's glands may serve a protective function by secreting antimicrobial compounds that help prevent urinary tract infections 4

Diagnostic Approach

• Evaluate for excessive ejaculation by assessing:
  • Volume of fluid (true ejaculate is typically only a few milliliters) 3
  • Consistency of fluid (ejaculate is thick and milky versus clear and watery) 3
  • Timing of fluid release (during orgasm versus during penetration or other times) 3
• Rule out other causes of genital fluid release:
  • Coital incontinence (stress or urge-related) 3
  • Squirting (larger volume transurethral expulsion) 3

Treatment Algorithm

First-Line Approach

1. Pelvic Physical Therapy
   • Recommended as first-line treatment for dysfunction related to pelvic floor muscles 1
   • May help regulate muscle function around the Skene's glands and urethra 1
   • Can improve control of ejaculatory function 1

Second-Line Approaches

1. Pharmacological Management (if physical therapy is insufficient)

   • SSRIs (paroxetine, sertraline, citalopram, fluoxetine)
     • May help regulate ejaculatory function 1
     • Typically dosed daily for ongoing management 1
   • Clomipramine
     • Can be used on-demand before sexual activity 1
     • May help with ejaculatory control 1

2. Hormonal Assessment

   • Consider evaluation for hormonal factors that might influence glandular function 1
   • Testosterone levels may affect sexual function and ejaculatory patterns 1

Adjunctive Measures

• Lifestyle Modifications

  • Smoking cessation, weight management, and physical activity 1
  • Reduction in alcohol consumption 1
  • These measures improve overall sexual function and may help regulate glandular secretions 1

• Psychological Support

  • Consider referral for sexual counseling if distress is significant 1
  • Addressing psychological factors may help with management of symptoms 1

Important Considerations and Caveats

• Limited Evidence Base: There is a notable lack of high-quality studies specifically addressing excessive female ejaculation 2
• Avoid Surgical Approaches: Surgical management of ejaculatory disorders should be considered experimental and only used in clinical trials 1
• Differential Diagnosis: Ensure proper differentiation between true ejaculation, squirting, and coital incontinence, as management differs 3
• Partner Involvement: When possible, include partners in education and management planning 1
• Regular Reassessment: Monitor response to interventions and adjust treatment plan as needed 1

Special Situations

• If excessive ejaculation is causing significant distress or affecting quality of life, a combined approach using both physical therapy and pharmacological management may be more effective than either alone 1
• For patients with concurrent sexual dysfunction issues (such as orgasmic disorders), additional targeted therapies may be necessary 5