Paraurethral Skene glands are considered the homologue of the prostate in females [16, 17]. Controversy exists on the function of Skene glands, their role in sexual function, female orgasm and ejaculation, and even their anatomy. Infection in these glands was described with gonorrheal infection in 1672 by Regnier de Graaf (1641–1693), which was long before Skene described them in 1880. Asymptomatic cysts of the duct or gland are uncommon; when infection occurs, it can cause pain, dysuria, vaginal discharge, and dyspareunia. On examination a palpable painful mass is present next to the distal urethra, and purulent material can be expressed from the ductal orifice. Skene abscesses can be distinguished from urethral diverticulum, which is usually more proximal and communicates with the urethra through a diverticular orifice. When doubt exists, imaging with positive pressure urography using a Trattner catheter, ultrasound, or MRI can be helpful [18].

Urethral diverticulum in women may be more common than has been suspected and should be excluded in patients with chronic irritative voiding symptoms, post void dribbling, or dyspareunia. The pathogenesis of this condition is poorly understood, and these lesions represent a spectrum of disorders ranging from isolated suburethral cysts to herniation of the urethral lining into the vaginal mucosa. Urethral diverticula usually are small, varying from 3 mm to 3 cm in diameter. Although most diverticula lie posterior to the urethra, they can also be located laterally or anteriorly, or even partially or completely surround the urethra (saddle diverticulum). Accurate diagnosis is based on history and clinical evaluation. Perineal ultrasound and MRI have been used for diagnosis. A diverticulum may fill during the voiding phase of urography or cystourethrography, presenting as a well-contained fluid collection adjacent to the urethra. Assessing urethral diverticula by sonography was first introduced by Lee and Keller [20]. Ultrasonography can be used to help differentiate solid from cystic suburethral masses, to identify stones within diverticula, and to visualize intraluminal masses (e.g., carcinoma, nephrogenic adenoma, mesonephric adenocarcinoma) [21].

The distal mesonephric ducts in the female are resorbed but may persist as vestigial remnants in the anterolateral vaginal wall down to the hymen (Gartner duct cysts) and between the layers of the broad ligament (paraovarian cysts). These cysts are usually small and asymptomatic and have been reported to occur in as many as 1% of all women [23, 24]. Because the ureteral bud also develops from the Wolffian duct, it is not surprising that Gartner duct cysts have been associated with ureteral and renal abnormalities in addition to associated anomalies of the female genital tract [25–28]. Ultrasonography of the upper and lower urinary tract is a noninvasive useful initial investigation. The Gartner duct cysts can be elusive and result in varied fistulas, including urethrovaginal fistulas [29]. Gartner duct cysts can have varied clinical presentations and 3D EVUS characteristics.

Although uterine fibroids are common uterine benign neoplasms worldwide, and many treatment options exist for them, reports of vaginal fibroids are scarce in the literature [30]. The boundaries of such mesodermal tumors are difficult to delineate, but most of the tumors are benign. Even recurrence does not signify malignant alteration. Vaginal leiomyoma presenting as a mass is most often diagnosed clinically and removed during surgery. An uncommon presentation may necessitate imaging studies. The lesion described can have MRI and ultrasound features similar to its uterine counterpart.