Congenital cervical malformations (CCMs) are rare obstructive types of female genital tract anomaly caused by bilateral Müllerian fusion abnormalities, and later canalization abnormalities. CCMs are the most challenging cases to manage and were related to poor functional and reproductive prognosis. The evaluation of a patient suspected of CCMs should include a detailed medical history, physical examination, and imaging tests. Pelvic magnetic resonance imaging is recommended for diagnosis and to subclassify the anomaly. Hysterectomy has been the mainstay treatment for CCMs for many decades. With the advancements in surgical techniques and reconstructive materials, conservative surgeries have now been proven to be effective and safe to restore the anatomy, relieve symptoms, and preserve the patients’ reproductivity.