Vaginal leiomyoma is a rare tumor with a variable clinical presentation and a broad differential diagnosis that can be confounded with pelvic organ prolapse, as in this case. We present a case of vaginal leiomyoma without urinary symptoms but with mild vaginal discomfort. A 59-year-oldG4P4 postmenopausal woman presented with a 5-year history of progressive sensation of prolapse and recurrent vaginal discharge, but without urinary tract symptoms. She was referred with a diagnosis of stage 3 uterine prolapse. Simple external genital examination revealed a smooth mobile 6.5× 4.5 cm vaginal mass arising from the anterior vaginal wall, inferior and lateral to the urethra. Digital examination revealed a solid, mobile, paraurethral, vaginal mass, without evidence of pelvic relaxation. Ultrasonography and selective hematology work up were normal. Under spinal anesthesia, the mass was enucleated through a vertical incision, the urethra being continuously protected by inserting a Foley catheter and retracting it laterally to avoid inadvertent urethral compromise. Histology confirmed a benign leiomyoma. The evaluation of an anterior wall vaginal mass must include a thorough pelvic examination and may require urethrocystoscopy or other investigations such as positive-pressure urethrography. Surgical enucleation via a vaginal approach is the treatment of choice. Histology should be sent for precise identification of the mass.

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