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Prolapsed uterine leiomyoma (fibroid)

Author
William H Parker, MD
Section Editors
Robert L Barbieri, MD
Howard T Sharp, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Uterine leiomyomas (fibroids) are common benign smooth muscle tumors [1,2]. Fibroids may develop anywhere within the muscular wall of the uterus, including submucosal, intramural, or subserosal positions (figure 1). For women with a pedunculated submucosal fibroid that is contained within the uterine cavity, removal is typically performed using hysteroscopy. Infrequently, uterine contractions will push a pedunculated submucosal fibroid through the cervical canal and it may prolapse into the vagina [3]. Pedunculated fibroids that dilate the cervix or prolapse through the cervix into the vagina can usually be removed via the vagina.

Removal of subserosal or intramural fibroids through a vaginal colpotomy incision is an uncommonly performed procedure that has also been referred to as vaginal myomectomy [4]. This approach has been associated with an increased risk of infection compared with other surgical approaches to myomectomy. This procedure is not discussed here.  

Vaginal myomectomy for a prolapsed submucosal uterine fibroid is reviewed here. Hysteroscopic, abdominal, and laparoscopic approaches to myomectomy are discussed separately. (See "Hysteroscopic myomectomy" and "Abdominal myomectomy" and "Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids)".)

INCIDENCE AND RISK FACTORS

There are no data regarding the incidence or risk factors of prolapsed uterine leiomyomas in particular. In general, uterine leiomyomas are the most common type of common pelvic tumor in women, with a prevalence of up to 80 percent. Submucosal fibroids account for approximately 15 to 20 percent of these and an unknown proportion of submucosal leiomyomas prolapse through the cervix. In our experience, this clinical finding is uncommon, but is not exceedingly rare. The epidemiology and risk factors of uterine leiomyomas are discussed separately. (See "Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids)", section on 'Prevalence' and "Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids)", section on 'Risk factors'.)

CLINICAL PRESENTATION

Prolapse of a submucosal leiomyoma through the cervix may present with symptoms of vaginal bleeding, discharge, or pelvic pain. Some women are asymptomatic, and the finding is noted incidentally on pelvic examination.

                        

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 14 00:00:00 GMT+00:00 2015.
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