A rare case of rapidly growing vaginal leiomyoma initially mimicked a prolapsed uterus. After careful examination, we confirmed the diagnosis and removed the leiomyoma via simple excision. The clinical presentation, ultrasound findings, cystoscopic, and surgical findings are presented. The characteristics, differential diagnosis, association with pregnancy, presurgical evaluations, including sonography, intravenous pyelography and magnetic resonance imaging of vaginal leiomyoma, are discussed. (J GYNECOL SURG 19:33)