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Cervical Myomas

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by S. Gene McNeeley, MD

Cervical myomas are smooth, benign tumors in the cervix.

  • A myoma may bleed, become infected, interfere with urinating, or cause pain during sexual intercourse.

  • Doctors can see or feel most myomas during a pelvic examination.

  • Myomas that cause symptoms can be removed surgically.

Myomas are benign tumors composed partly of muscle tissue. They seldom develop in the cervix, the lower part of the uterus. When they do, they are usually accompanied by myomas in the larger upper part of the uterus. Myomas in this part of the uterus are also called fibroids (see Fibroids).

Large cervical myomas may partially block the urinary tract or may protrude (prolapse) into the vagina. Sores sometimes develop on prolapsed myomas, which may become infected, bleed, or both. Prolapsed myomas can also block the flow of urine.

Symptoms

Most cervical myomas eventually cause symptoms. The most common symptom is

  • Bleeding from the vagina, which may be irregular or heavy

Heavy bleeding can cause anemia, with fatigue and weakness. Sexual intercourse may be painful.

If myomas become infected, they may cause pain, bleeding, or a discharge from the vagina.

Rarely, prolapse causes symptoms such as a feeling of pressure or a lump in the abdomen.

If a myoma blocks the flow of urine, women may have a hesitant start when urinating, dribble at the end of urination, and retain urine. Urinary tract infections are more likely to develop.

Diagnosis

  • Pelvic examination

  • Sometimes ultrasonography

Doctors can often detect myomas during a physical examination. During a pelvic examination (see Gynecologic Examination), doctors may see a myoma, particularly if prolapsed. Or doctors may feel a myoma when they check the size and shape of the uterus and cervix (with one gloved hand inside the vagina and the other on top of the abdomen).

If the diagnosis is uncertain, doctors may insert an ultrasound device through the vagina into the uterus to obtain an image of the area. This procedure, called transvaginal ultrasonography, is also done to check for blockage of urine flow and for additional myomas.

Blood tests are done to check for anemia.

A Papanicolaou (Pap) or human papillomavirus (HPV) test (called cervical cytology tests) is done to rule out cancer of the cervix.

Treatment

  • If myomas cause symptoms, surgery

If myomas are small and do not cause any symptoms, no treatment is needed.

If they cause symptoms, they are surgically removed if possible (a procedure called myomectomy). If only the myoma is removed, women can still bear children. However, if myomas are large, removal of the entire uterus (hysterectomy) may be necessary. Either procedure can be done by making a large incision in the abdomen (laparotomy). Sometimes these procedures can be done with instruments inserted through one or more small incisions near the navel (laparoscopy).

If a myoma prolapses, it is removed with instruments inserted through the vagina (transvaginally) if possible.