Cervical myomas are uncommon. Uterine myomas (fibroids) usually coexist. Large cervical myomas may partially obstruct the urinary tract or may prolapse into the vagina. Prolapsed myomas sometimes ulcerate, become infected, bleed, or a combination.
Symptoms and Signs
Most cervical myomas eventually cause symptoms. The most common symptom is bleeding, which may be irregular or heavy, sometimes causing anemia. Dyspareunia may occur. Infection may cause pain, bleeding, or discharge.
Rarely, prolapse causes a feeling of pressure or a mass in the pelvis.
Urinary outflow obstruction causes hesitancy, dribbling, or urinary retention; UTIs may develop.
Diagnosis
Diagnosis of cervical myomas is by physical examination. Cervical myomas, particularly if prolapsed, may be visible with use of a speculum. Some are palpable during bimanual examination. Ultrasonography or MRI can help with the diagnosis.
Transvaginal ultrasonography or MRI is done only for the following reasons:
Hemoglobin or hematocrit is measured to exclude anemia. Cervical cytology is done to exclude cervical cancer.
Treatment
Treatment of cervical myomas is similar to treatment of fibroids. Small, asymptomatic myomas are not treated. Most symptomatic cervical myomas are removed by myomectomy (particularly if childbearing capacity is important) or, if myomectomy is technically difficult, by hysterectomy.
Prolapsed myomas should be removed transvaginally if possible.
Key Points
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Cervical myomas are benign.
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Most cervical myomas eventually cause symptoms, mainly bleeding; large myomas may partially block the urinary tract or prolapse into the vagina.
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Diagnose cervical myomas by physical examination and sometimes transvaginal ultrasonography or MRI.
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Surgically remove symptomatic cervical myomas, usually by myomectomy but, if myomectomy is not possible, by hysterectomy.
