Leiomyoma is a benign mass of smooth muscle cells that most frequently occurs in the gastrointestinal and genitourinary system. However, leiomyomas arising from the female urethra, especially paraurethral, are exceedingly rare. We present a case of a true paraurethral leiomyoma. The initial presenting complaints were dyspareunia, increased urinary frequency, and a 1.8 cm lesion in the anterolateral wall of the vagina that was suspicions of a Gartner's duct cyst. However, the patient was lost to followup for 5 years. On return, the patient continued to complain of dyspareunia, urinary frequency, suprapubic pain, and dysuria. The patient was treated for multiple instances of urinary tract infections (UTIs) without symptomatic improvement. A pelvic MRI demonstrated a 3.8 x 4.1 x 4.7 cm mass within the left anterior aspect of the lower cervix/vagina. Cystoscopy was notable for an unremarkable urethra with an anterior vaginal wall mass extrinsically pushing the bladder trigone without penetration into the bladder mucosa or communication with the ureter or vagina. A biopsy from the paraurethral mass revealed well-delineated cells with low mitotic figures encompassed in a fibrous capsule non-adherent to adjacent structures. The mass was subsequently excised through the anterior vaginal wall with no complications and complete resolution of symptoms.