THE EFFECT OF USING RED BETEL LEAVES
(Piper crocatum) FOR VAGINAL DISCHARGE AMONG
FERTILE AGE WOMEN (FAW)

Tisnawati1*, Etri Yanti2, Yusriana3
1Lecturer, Padang Health Polytechnic, West Sumatera, Indonesia
2Lecturer, Syedza Saintika Health College, Padang, West Sumatera, Indonesia
3Lecturer, Mercubaktijaya Health College, Padang, West Sumatera, Indonesia
*Corresponding Author Email: tisnawatitiss@yahoo.co.id

INTRODUCTION
For a woman, maintaining cleanliness and a shape
of the body is very vital, but there are still women who
do not really care about the cleanliness of their
reproductive organs. Most of the women are
complaining about the diseases that disrupt daily
activities, like vaginal discharge. Sometimes women
who suffer from vaginal discharge would have
psychiatric reactions, fear and excessive anxiety. This
situation causes the women to feel less condent, so
they withdraw themselves from the society which is
ultimately dangerous to the individuals (Rozanah,
2003).
Health problem among women all over the world
reveals that 33% of the total burden of disease
affecting women is due to worst cases in the
reproductive age. This number is greater than the
reproductive problems in men, which is only 12.3% of
men in the same age group as women The incidence of
vaginal discharge among women in The world,
Europe and in Indonesia is quite high. Vaginal
discharge or Fluor Albus is women's abnormal vaginal
secretion. Vaginal discharge or Fluor Albus, women's
abnormal vaginal secretion is caused by an infection
which is followed by itchiness in the vagina and
around the outside of genital lips. As a result of this,
she feels uncomfortable in the vaginal area (Yohana
and Yovita, 2012).
In general, vaginal discharge can be caused by
several factors: the lack of attention to the cleanliness
of vaginal organs, washing the organs in the wrong
way, tiring physical activity, not replacing the pads
22 VOL. 8 (3) JANUARY 2017 THE MALAYSIAN JOURNAL OF NURSING

properly during menstruation, less healthy life, under
stressful psychiatric conditions, using excess soap to
clean the sensitive organs, humid weather, changing
partners often for doing sex activity, the condition of
hormonal imbalance or often scratching the genital
organs.
One of the other causes of the emergence of
vaginal discharge is a fungal infection Candida
albican. Candida albicans fungus is classied as a
dimorphic fungus. Candida albicans is found in some
parts of the body of a healthy person, such as in the
mouth, esophagus, intestines, genital tract, feces,
under the nails and skin. An infection caused by
Candida is called Candidosis. Vagina Candidosis is
vaginitis which is caused by Candida albican fungus.
The main symptom of this infection is Flour Albus
(vaginal discharge), often followed by itching.
Typically, these infections occur due to pollution after
defecation, from infected nails or water that has been
contaminated by the fungus and is used to wash the
genital organs (Hamid, 2012).
The effect of this abnormal vaginal discharge, if it
is neglected without treatment, may result in the
spread of the infection into the uterus, fallopian tubes
and also can infect the ovaries. These conditions can
damage the reproductive organs inside and can also
lead to infertility. Therefore, keeping personal
hygiene is important to prevent a vaginal discharge
(Hediyani, 2012).
The research data about reproductive health
shows that 75% of women in the world get a vaginal
discharge and 45% of them may experience vaginal
discharge as much as 2 times or more. From a study, it
is evident that 3 of every 4 women in the world have
experienced vaginal discharge at least once in their
life. Every woman can be affected by these disorders
without looking at the background and the profession
(Bahari, 2012).
According to Muninjaya, Anak Agung Gede
(2004) and Solikhah, Marsito, Nurlaila (2010) it is
reported that in Indonesia the problem of vaginal
discharge increased more than 75% among the women
due to the moist weather in Indonesia. They are easily
infected with the fungus Candida albicans, parasites
such as pinworms or bacteria (Trichomonas vaginalis).
They reported that in 2007 as many as 60% of
Indonesian women have experienced vaginal
discharge, while in 2008 as many as 70% of Indonesian
women have experienced vaginal discharge.
Vaginal discharge has been a problem for women
for a long time. Not all of the women know about
vaginal discharge and sometimes underestimate this
issue. Vaginal discharge cannot be considered as
unimportant because the effect can be very fatal if it is
late to handle. Not only can it lead to infertility and
pregnancy outside the womb, vaginal discharge can
also be an early symptom of cervical cancer leading to
death. Vaginal discharge also can affect a person's
psychology because it tends to relapse and recur so
that it can affect a person both physiologically and
psychologically (Suhandi, 2012).
Treatment of vaginal discharge can be done only
by using the pharmacological treatment methods or
using drugs such as Gentian violet 1%, Nitronidazole
2x1 tablet (500 mg) for 10 days, antibiotics like
ampicillin 3x1 tablet (500 mg) for 3 days in a row. But
if the drug is consumed continuously, there would be
side effects including nausea, abdominal pain,
diarrhea, headache, irregular menstruation, allergic
reactions (skin rash, itching) and can cause liver
damage. Besides pharmacological treatment, nonpharmacological
treatment or traditional medicine
can cure vaginal discharge. One such traditional
treatment is the use of red betel leaf to treat vaginal
discharge, besides being a natural material is that red
betel is very easy to use, easily available and do not
require high costs like antibiotics.
Red betel leaf (Piper crocatum) is a medicinal
plant which is very benecial. The Anthocyanin
content is high, indicating its antioxidant property. The
red betel leaf is used to reduce vaginal discharge and
keeping vaginal areas clean due to its antiseptic
property. It is easy to start using red beetle leaf by
boiling seven leaves then using the boiled water to
rinse the genital organs (Ismawan, 2012). The taste of
red betel leaves is very bitter. It has the strong aroma
when compared with green betel. The red betel leaves
contain avonoids, polevenolad compounds, tannins
and essential oils. The effect of an active substance in
the red betel leaf can stimulate the central nerve and
thinking power. The Red betel leaf extract is also
capable of exterminating Candida albican fungus
DISCHARGE AMONG FERTILE AGE WOMEN (FAW)
VOL. 8 (3) JANUARY 2017 THE MALAYSIAN JOURNAL OF NURSING 23
causing sprue. Moreover, it can reduce secretions in
the vagina, vaginal discharge and itching of the
genitals, as well as wound cleansing (antiseptic effect).
Based on UPT Padang City Nanggalo District of
Family Planning (2012), it was found that the number
of fertile women in Kelurahan Surau Gadang was as
many as 6259, in the Kelurahan Kurao Pagang it was
2,592 people and in the Kelurahan Gurun Lawas was
as many as 1,236 people. Of the three villages in the
district of Padang Nanggalo, Kelurahan Surau
Gadang is the village that has maximum fertile age
women with 6259 individuals. From the initial survey
conducted interviewing 10 women in the fertile age
with vaginal discharge in Surau Gadang work area at
Health Public of Center Nanggalo Padang, it was
found that only 3 (30%) of these fertile women used
boiled water of red betel leaves to treat vaginal
discharge. All of them agreed that red beetle leaf is a
good treatment for vaginal discharge. But 7 (70%) of
them did not use the red betel leaf to treat vaginal
discharge because they did not agree with the
treatment, as they think it is not a big deal.
Based on the information above, the researchers
were interested in increasing the awareness regarding
the inuence of using red betel leaves boiled water for
healing vaginal discharge among fertile age women
(FAW) in Surau Gadang work area at Health Public of
Center Nanggalo Padang.
RESEARCH METHODOLOGY
This research uses a Quasi-Experiment which is
structured to determine an indication or effect, as a
result of certain treatment. This study uses two groups
as both pretest and for posttest design. The pretest is
done before the application of boiled water red betel
leaves and then after being given red betel leaves
boiled water once a day for 7 days, the calculations
was done again (post-test) to nd healing on the
vaginal discharge after the treatment.
Research has been conducted in Surau Gadang
work area Public Health Center of Nanggalo Padang
from June 3rd to July 2nd, 2014. The individuals in this
study consisted of all fertile age women experiencing
vaginal discharge. The total number of study group
consisted of 107 individuals. Samples are calculated
by using estimated proportion formula with formula
nite population (Lemeshow, 1997):
Description:
P = vaginal discharge case proportion 75% = 0, 75
N= population
d = precision or trusting level 10% = 0,1
So, the total of the samples in this study is 43
individuals.
1. Inclusion Criteria
a. Fertile age women who reside in Kelurahan
Surau Gadang at Public Health Center of Nanggalo
Padang.
b. Fertile age women who are willing to be
respondents
c. Fertile age women who experienced vaginal
discharge with a pH of ≥5
d. Fertile age women who were currently in that
place where the research was held.
2. Exclusion Criteria
a. Fertile age women who experienced vaginal
discharge with a pH ≤5
b. Fertile age women who were not willing to be
respondents.
Based on the inclusion and exclusion criteria
above, it was found that eligible sample quantitates to
as many as 34 people.
The sampling technique used in this research is the
purposive sampling technique which means that the
researchers during initial screening went to the
respondent's houses to conduct a pre-test with litmus
paper on fertile age women with vaginal discharge.
Then the sample is selected based on the inclusion
criteria.
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24 VOL. 8 (3) JANUARY 2017 THE MALAYSIAN JOURNAL OF NURSING
MATERIAL AND METHODS
a. Tools and materials:
1) 7 fresh medium sized red betel leaves
2) 1 liter of clean water
b. Procedure of Preparation and Use:
1) The red betel leaves was washed until they are
clean
2) 1 liter of water was boiled
3) After 15 minutes the red betel leaves boiled
water was lukewarm
4) This red betel leaves boiled water was then
used from the front to backward by ushing on
vaginal area
5) This was repeated once every day after a bath
or when going to bed at night.
The research instruments are the tools that will be
used for collecting data (Notoadmojo, 2010). In
collecting data, researchers used observation sheet and
litmus paper.
The data processing is done by using computers
and the steps as follows: checking the data (Editing),
encoding the data (Coding), entering the data (Entry),
and data cleaning (Cleaning). The data were analyzed
by using univariate and bivariate analysis to determine
the average value, mean, median, maximum value,
minimum value and standard deviation both in pretest
and post-test. Bivariate analysis was used to see the
impact of using red betel leaves boiled water for
vaginal discharge healing. This study was conducted
only on an average of two values by using the bivariate
test which is the average of two different tests and test
used non-parametric statistical test with Wilcoxon
Test, p value > α (0.05).

RESULTS
Result of using red betel leaves boiled water for
healing vaginal discharge to Fertile Age Women
(FAW) in Surau Gadang Work Area at Health Public of
Center Nanggalo Padang 2014:
Univariate Analysis
pH of vaginal discharge before and after the use of
red betel leaves boiled water.Table 1.
Table 1.
The Vaginal Discharge pH distribution before and
after the use of red betel leaves boiled water to fertile
age women (FAW) in Surau Gadang Work Area at
Health Public of Center Nanggalo Padang 2014
Variable Mean SD Min Max N
pH Before Usage red
betel leaves boiled
water.
2.00 0.000 2 2 34
Vaginal discharge pH
after Using red betel
leaves boiled water
1.21 0.410 1 2
Bivariate Analysis:
Before analyzing with bivariate analysis, it must
be done rstly by the normality test named
Kolmogorov - Smirnov test. The p-value for pH will
be determined by using red betel leaves boiled water
0.000 and pH after using red betel leaves boiled water
0.000. Thus it can be stated that the pH before and
after the application of red betel leaves boiled water is
not normal in distribution. Therefore non-parametric
statistical test will be conducted, namely Wilcoxon
test. The data will be further processed by bivariate
analysis to determine whether there is an inuence of
using red betel leaves boiled water to cure vaginal
discharge. The results of the bivariate analysis by the
researchers are:
The average pH of vaginal discharge among
fertile women age in the rst measurement is 2.00
with a standard deviation of 0.000. On the second
measurement after the use of red betel leaves decocted
water, it can be found that average pH of vaginal
discharge among fertile women age is 1.21 with a
standard deviation of 0.410. Statistical test results
obtained p value = 0.000. It can be concluded that
there is a signicant difference between the pH before
and the pH after using red betel leaves decocted water
among the experiment group.

DISCUSSION
Based on the research result on the inuence of the
use red betel leaves boiled water to cure vaginal
discharge in fertile age women (FAW) are as follows:
a. pH of Vaginal Discharge Before:
The use of Red Betel Leaves Boiled Water Based
on the research results, it can be concluded that vaginal
DISCHARGE AMONG FERTILE AGE WOMEN (FAW)
VOL. 8 (3) JANUARY 2017 THE MALAYSIAN JOURNAL OF NURSING 25
discharge pH before being given red betel leaves boiled
water was 2.00 on average, SD 0000, Min 2 and Max 2.
According to the theory of Bahari, (2012), one of
the causes of vaginal discharge is a Candida albicans
fungal infection. Candida albicans fungus is
classied as a dimorphic fungus, which enjoys a wet
and humid place. The infection caused by Candida is
called Candidiasis. Vaginal Candidiasis is vaginitis
which is caused by the Candida albican fungus.
Usually, the infection is caused by contamination after
defecation or polluted water used to wash the genital
organ. Furthermore, Yohana and Yovita (2012) stated
that the discharge caused by the infection is usually
accompanied by intense itching in the vagina and
outside around the genital lips so that women feel
uncomfortable in that area.
According to the researchers' analysis, vaginal
discharge in the fertile age women is not only caused
by the lack of hygiene of the genital organs but also
caused by the Candida albicans fungus. From the
results of research among the fertile age women who
suffered from vaginal discharge, it can be said that the
infection is due to bad habit of using damp and tight
clothes. This proved that the measurement of pH ≥ 5
leads to vaginal discharge accompanied by itching in
the vagina and around the outside of genital lips.
b. pH of Vaginal Discharge After The Use of Red
Betel Leaves Boiled Water
Based on the research results it can be concluded
that vaginal discharge pH after being given red betel
leaves boiled water was 1.21, SD 0410, Min 1 and
Max 2.
The results of this study are consistent with Dina
(2012) on the use of red betel leaves boiled water to
treat vaginal discharge. The results showed that 70% of
women are cured after the use of the red betel leaf. The
recovery in most of the fertile age women (FAW) after
being given red betel leaves boiled water was due to the
eugenol present in it that is capable of eradicating the
Candida albicans fungus. In accordance with the
theory of (Waskito, 2008) red betel leaf is widely used
to treat various diseases, such as to lower the pH of the
vagina and treat vaginal discharge. The eugenol is an
analgesic which relieves the pain. There is also tannin
content in the leaves which are benecial to reduce the
secretion of uid in the vagina.
According to Sadewo, (2002), the efcacy of red
betel leaf lies in the fact that it reduces vaginal
discharge and keep the sensitive organs clean because
red betel leaves have one of the advantages of being
antiseptic. Boiling 7-10 red betel leaves and then
using the boiled water to rinse the genital organs is
consequently very effective. The boiled water
contains antiseptic property which can be used to cure
vaginal discharge and odor around it.
Furthermore Bahari, (2012) stated that in general,
vaginal discharge can be caused by several factors,
like the apathetic of cleanliness of the vaginal area,
ushing it in wrong way, tiring physical activity, not
replacing the pads properly during menstruation, less
healthy life, under stressful psychiatric conditions,
using excess soap to clean the sensitive organs, the
weather especially the humid conditions, often
changing partners for doing in sexual activity,
hormonal imbalance, scratching the genital organs,
and wearing tight underwear of synthetic materials.
According to the researcher's analysis after using
red betel leaves boiled water, the fertile age women
feel happy because the discharge begin to diminish.
FAW also stated thar after ushing with the decoction,
they no longer experienced itching and discomfort in
their genital areas. There is also tannin content in the
leaves that are benecial to reduce the secretion of
uid in the vagina. This proved that red betel leaf
boiled water is effective for treating vaginal
discharge, which is evident from the measurement
results obtained with pH ≤ 5. Therefore, it is
recommended to the woman of fertile age (WUS) to
use red betel leaves boiled water to treat vaginal
discharge.
c. pH of Vaginal Discharge Before and After The
Use of Red Betel Leaves Boiled Water
The average pH of vaginal discharge before and
after the use of red betel leaves boiled water in the rst
measurement was 2.00 with a standard deviation of
0.000. On the second measurement or after using red
betel leaves boiled water the pH is 1.21 with a standard
deviation of 0.410. It can be concluded that there is a
signicant difference between the pH of vaginal
discharge before and after the use of red betel leaves
boiled water. Effective use of the red betel leaf boiled
water is very benecial for the fertile age women
DISCHARGE AMONG FERTILE AGE WOMEN (FAW)
26 VOL. 8 (3) JANUARY 2017 THE MALAYSIAN JOURNAL OF NURSING
(FAW) because they have a partner. Therefore their
partners are susceptible to get infected by the vaginal
discharge. Therefore, the germ in the discharge can
cause venereal disease that may infect their partner.
This can cause unfavorable impact on the fertile age
women. According to Hediyani, (2012), if vaginal
infection remains untreated then the infection might
spread into the uterus, fallopian tubes and also can be
infect the ovaries. These conditions can damage the
reproductive organs inside and can also lead to
infertility. Therefore, it is crucial to maintain personal
hygiene to prevent vaginal discharge. Therefore, it is
highly recommended to fertile age women (FAW)
who experience vaginal discharge to use red betel
leaves boiled water in healing.
CONCLUSION
This study would help to develop skills in
applying knowledge that is already obtained in
college and to get more understanding about this
matter. It is expected that the nursing education
institutions must implement health education,
particularly on the use of red betel leaf to cure vaginal
discharge. The heads and nurses at Health Public of
Center Nanggalo Padang can disseminate, implement
and evaluate the implementation of the use of red betel
leaf decoction water to cure vaginal discharge in
fertile age women. This data can be used as reference
material or for comparison in future studies with the
same problem with different variables.

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