Perianal leiomyoma is closely associated with HPV infection, manifests as bleeding, pain, and treatment is based on radiotherapy. Perianal leiomyoma is common in patients with anal sex, multiple sexual partners, history of cervical, vulvar, and vaginal tumors, use of immunosuppressive drugs, immunosuppression due to HPV infection, and smoking. Clinical manifestations of perianal leiomyoma include bleeding, anal pain, localized itching, pus, urgency (discomfort in the lower abdomen, urge to defecate, and a feeling of incomplete defecation after defecation), and change in bowel habits. At present, simultaneous radiotherapy and chemotherapy have replaced local excision as the main treatment modality. All patients with perianal leiomyosarcoma need to be followed up regularly, and if regional progression is found in the review, symptomatic treatment can be given in time. Personal hygiene, HPV vaccination and regular screening can prevent perianal leiomyoma. If the diagnosis of perianal leiomyoma is confirmed, it is recommended to actively cooperate with the doctor’s treatment, so as not to delay the condition.