Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarely develop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. The presentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusual appearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinary symptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia, cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. The patient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily be misdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginal protrusion should be approached with a high index of suspicion, especially in patients of reproductive age.