Of those with uterine leiomyomas, 29% result in hospitalizations. One-third of patients with these fibroids experience life-threatening anemia, a condition where the body does not have enough oxygen due to lack of red blood cells to carry oxygen throughout the body. These tumors are mainly treated by performing hysterectomies, a procedure in which the uterus is removed, and account for approximately 40-60% of all performed hysterectomies. Symptoms are dependent on the location of the tumor, which may occur in the submucosal (under the mucous membranes and lines the inner part of some organs), intramural (within the walls of the organs), or subserosal areas (under the serosa and lines the outer part of some organs). Nipple-areolar
Nipple-Areolar leiomyoma is a rare type of genital leiomyoma. It presents as either unilateral or bilateral growth of benign tumor of the smooth muscle that can be painful, tender, and inflamed. They are typically less than 2 cm in length. Since this is an extremely rare tumor, with only 50 cases reported in literature, it often only reported to physicians due to chronic nipple pain. Vaginal
Vaginal paraurethral leiomyoma is another type of genital leiomyoma that is also less common compared to other types of leiomyoma. It presents as a benign tumor of the smooth muscle in the genitourinary tract, which includes urinary and genital organs, that can grow rapidly during pregnancy. On the other hand, the tumor tend to decrease in size upon menopause. This may be due to the growth of tumor that is dependent on hormones.
Those who have genital leiomyomas can be asymptomatic or symptomatic. Symptoms including but not limited to pelvic pain or abnormal menstrual bleeding are used to assess fibroids. Imaging are often used to detect the presence of fibroids, particularly uterine fibroids. This includes ultrasonography, a procedure that uses high-frequency sound waves to capture tissue and organ images; Sonohysterography, a painless procedure similar to ultrasonography to capture images inside the uterus; Hysteroscopy, which examines the inside of the uterus and cervix using a flexible tube called hysteroscope. Treatment
Treatment for genital leiomyomas primarily consist of removal by surgeries. However, genital leiomyomas typically re-occur and may reappear from 6 weeks to over 15 years post-removal. When managing leiomyomas, radiation treatment should be avoided due to the inducing effect of malignant transformation in the smooth muscle of the tumor.For uterine leiomyomas, complete removal of the uterus is required. There is minimal evidence to support the use of myomectomy to preserve fertility. Evidence shows that preoperative use of gonadotropin-releasing hormone agonists, which prevents or lessen the production of hormones like progesterone, estrogen, and testosterone, can reduce surgical complications.Subareolar leiomyomas require surgical removals. Precise surgical margins are needed to prevent re-occurrences.Leiomyomas in the scrotum require an orchidectomy, or surgical removal of one or two testicles. To manage pain that arises from the fibroids, drugs that affect smooth muscle contraction such as nitroglycerin, nifedipine, phenoxybenzamine and doxazosin can be employed to ease the pain. For nerve pain or tenderness, gabapentin and topical analgesics may be employed.