Introduction
Uterine lymomas are the most commonly occurring pelvic tumors in women [1]. Lymomes involve approximately 15-25% of women in fertility age [2]. They are benign monoclonal tumors derived from smooth muscle cells of myometritis [3]. Lymomes are created at the age of fertility and usually have symptoms such as uterine bleeding, pain and pressure. [1-4]. It may also have effects on the reproductive system, such as infertility and poor pregnancy outcomes [5].
Heavy and prolonged hemorrhage is a symptom of the myoma [6], but the bleeding during and after monoplasm is not a symptom of fibroma [5]. Dyspareunia (sexual intercourse pain) is seen in the anterior fibroids and fundus [6]. Dysmenorrhea also relates to high levels of blood or clots. [6] Treatment of fibroids is done by medication or surgery, and usually uterine fibroma is performed by surgery of the vaginal canal [7]. In severe bleeding, fibrillation and surgical removal are essential [3].
 
Patient and methods
The patient was a 25-year-old woman who had come to a women's clinic at Sarem Hospital due to severe vaginal bleeding that had begun three months earlier. During the study and routine tests, abnormal uterine bleeding (AUB) evaluation, reported hemoglobin in patients was 5. In ultrasound, heterogeneous mass of 26 × 31 mm was reported in the uterus which had vascularity in the Doppler. The patient was single and virgin, and due to severe anemia and hemorrhage, fibromial removal was essential for her. Initial treatments were performed to relieve bleeding and anemia. Typically, uterine fibroids are performed by surgery of the vaginal canal, which can be done by the resectoscope resection. However, the patient was not willing to undergo surgery for the vaginal canal because of virginity. Therefore, decision was made to perform abdominal surgery and to removel of fibroma. This patient was the fourth one to decide remove of fibroma in her uterus through abdominal myomectomy. After making necessary measures and delivering hemoglobin to 8.3 under general anesthesia, the skin was transdermally cut and after opening the abdominal layers, the bladder was detached from the uterus. With the incision of the upper extremity of the vagina, the uterus mass, which had a fibrofibre, was removed, and the uterine was restored with the vicryl yarn. The patient was monitored for 2 days and was discharged from the hospital with her good general condition and her and her family satisfaction with healthy virginity (Figures 1 and 2).

Figure 1) Transverse incision at the upper end of the vagina and removing the mass in this way

Figure 2) Suturing the upper end of the vagin

Discussion
Surgery of uterine fibroids is usually possible through vaginal and via resectoscope [7]. In cases where the uterine fibroids do not have a pedicle and is placed in the uterus and it is difficult to remove it from the vagina, surgery of uterine fibroids is recommended through an abdominal area[5-7]. In Islamic countries including Iran, considering the culture of the general public, virginity is very important [8]. In this particular case, due to the request of maintaining her virginity and its importance for the family, surgery for abdominal uterine fibroids was recommended. Although, the surgical procedure is followed by the scarring of abdominal surgery and postoperative pain [8], the result is the same as that of the removal of fibroma from vaginal canal [8-10].
 
Conclusion
So far, four of these surgical procedures have been carried out at Sarem Obstetrics and Maternity Hospital, which has not been performed in Iran until now. In the past, because of the weakness of surgical techniques, many young women lost their womb that if this technique were used, there was still a chance for pregnancy. Considering the general culture of Islamic countries, the vitality of virginity is very important. Therefore,  the mentioned surgical procedure is recommended in these special cases. A comparative study of the advantages and disadvantages of these two surgical methods is suggested in later studies.

Acknowledgements
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Ethical permissions
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Conflict of interest
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Contribution of authors
Ali Amini (First author), author of the article/methodology/main author/author of discussion (%60); Atieh Mirfendereski (Second author), author of the article/helper author/author of discussion (%40).