The Effect Of Green Betel Leaf Decoction (Betle Piper

L) On Vaginal pH Levels
Tessa Siswina1*, Henny Fitriani2, Santi Rahmawati3
1
Poltekkes Kemenkes Pontianak, Jl. Dr Soedarso, Pontianak, 78124, Indonesia
2 Poltekkes Kemenkes Pontianak, Jl. Dr Soedarso, Pontianak, 78124, Indonesia
3 Poltekkes Kemenkes Pontianak, Jl. Dr Soedarso, Pontianak, 78124, Indonesia

INFORMATION ARTICLES : ABSTRACT

According to WHO, almost all women and teenagers have experienced Fluor Albus 60%
History Pages : in adolescents (15-22 years) and 40% in women (23-45 years). Fluorine Albus occurs
Received Date Apr, 22, 2018 because the vaginal pH level is disturbed. PH balance is needed in the range of 3.8-4.2.
Unwise vaginal cleaning such as the use of water and soap, betel juice and other
Revised Date Apr, 24, 2018
commercial products can worsen the vaginal condition. Treatment with herbs is again
Published Date favored in this era of back to nature. Green betel leaf (Piper betle L.) is one of the plants
that grows in Indonesia. The content of phenol (karvacrol) and phenylpropane (eugenol
Keywords and kavikol) in essential oils of green betel leaf serves as an antiseptic (bactericidal and
Keyword 1 Green Betel Leaf fungicidal) which is very strong. Green betel leaf decoction water is used to cleanse the
Decoction female genitals and avoid vaginal discharge.
Keyword 2 Betle Piper L This research aim to find out whether there is an effect of water decoction of green betel
Keyword 3 Vaginal Ph Levels leaf (piper betle L) on vaginal pH levels.
The method using One group pretest-posttest design without control group. The
population was all students of D III Midwifery level I of Pontianak Health Ministry
Polytechnic at 44 people, and sampling technique with total population. Hypothesis
testing using Wilcoxon test.
There was a difference in vaginal pH levels before and after giving betel leaf water
decoction to the D III Midwifery Level I student of the Ministry of Health Poltekkes
Pontianak with a midpoint of vaginal pH level before being given a decoction of green
betel leaf at 4.00 and after being given green betel leaf decoction the average value is
3.00, has a difference in vaginal pH level 1.
Conclusion is there is an effect of giving water decoction of green betel leaf (piper betle
L ) on vaginal pH levels in the D III Midwifery Level I Student of the Ministry of Health
Poltekkes Pontianak.

INTRODUCTION Usually arises during menstruation or after

menstruation, according to the high and low
In Indonesia, almost all women and estrogen hormone in the blood (Boyke, 2004).
adolescents have experienced Fluor Albus 60% in The occurrence of Fluor Albus is caused
adolescents (15-22 years) and 40% in women (23- because the vaginal PH level is disturbed. Vaginal
45 years) according to WHO (World Health pH levels are important for health screening, and
Organization) in Suryandari (2013). Fluor Albus this acidic vaginal pH balance created by bacteria
or often known as vaginal discharge is excessive occurs normally. A healthy vagina produces fluid
fluid that comes out of the vagina. Normal vaginal to cleanse and regulate itself (Nurwijaya, 2009).
discharge is clear white, when attached to PH balance is neededin the range of 3.8-4.2. In the
underwear will be bright yellow consistency like vagina besides the normal flora there are also
mucus, dilute or thick (Indah, 2011). Fluor Albus, pathogenic bacteria, lactobacillus will be fertile
which is experienced by women of childbearing and pathogenic bacteria will die (Suryandari.
age, Fluor Albus is all the liquid expenditure of 2013). According to Donatila (2011) External
genetalia devices that are not blood. Fluor Albus vaginal douching is an activity of washing or
is not a separate disease, but is a symptom cleaning the outer vagina with certain ingredients.
manifestation of almost all uterine diseases Unwise vaginal cleaning such as the use of water
(Manuaba, 2009). Fluor Albus is a symptom of a and soap, betel juice and other commercial
disease that is characterized by discharge from the products can worsen the vaginal condition.
reproductive organs and not blood and is normal.

*Author Correspondence
Email Address : [email protected]
 Adolescence is also called adolescence midwife to prevent the occurrence of Fluor Albus
(growing into adulthood). Adolescence is can be done by providing counseling that is
characterized by puberty which is the time a maintaining the cleanliness of thearea genetalia
woman is able to experience conception, namely into, cleaning thearea genetalia from the front
menstruation / first menstruation. During this time back, do not use jeans that are very tight so that
adolescents experience sexual development disrupts vaginal moisture can affect changes in
including, the maturity of the sexual organs begins vaginal moisture and trigger vaginal discharge
to function, both for reproduction (producing (Suryandari, 2013) The job of a midwife if she
offspring) and recretion (having fun) meets fluorine Albus pathologist consult a health
(Moersintowati, 2002). Indonesian women who center, expert doctor and hospital (Manuaba,
have experienced this disease are very large, 75% 1998). Based on the background above the author
of Indonesian women must experience vaginal is very interested in conducting research with the
discharge at least 1 time in their lives. More than title "The Effect of Giving Green Betel Leaf
70% of Indonesian women experience vaginal (Water DecoctionPiper Betle L)on Vaginal PH
discharge caused by fungi and parasites or Levels".
protozoa (trichomonas vaginalis). This figure
differs sharply with Europe, which is only 25%. RESEARCH METHODS
Many Indonesian women experience vaginal
discharge because the soil is moist, so it is easily This study used aresearch design
infected with Candidaalbikans, the cause of quasy-experimental withapproach one
vaginal discharge, while in Europe it is dry grouppre-test and post-test. Treatment was
(Elistyawati, 2006). carried out in the treatment group for 3 days.
Medicines from natural ingredients have
been used by Indonesians for centuries in the Eksperiment 01 X 02
context of hereditary experiences (Suharmiati and
Figure 4.1 Research design of one group
Handayani, 2006). Treatment with herbs again
test and post test design.
favored diera back to nature . The implementation
Remarks:
of this herbal medicine has a legal basis, namely
01: Observation of vaginal pH levels before
the Minister of Health Regulation No.1109 /
treatment
Menkes / PER / IX / 2007. In accordance with the
X: Intervention (giving green betel leaf water
health minister's regulation, the use of traditional
decoction)
medicines is as aeffort promontive, preventive,
02: Observing vaginal pH levels after treatment
curative and rehabilitative in order to improve the
health status of the community (Maytasari, 2010).
Population is the overall source of data
Green betel leaf ( Piper betle L.) is one of
needed in a study. Determination of data sources
the plants that grows in Indonesia. Indonesian
in a study is very important and determines the
people themselves have used green betel leaves in
accuracy of research results. Data sources or
traditional medicine to strengthen teeth, heal small
research subjects have certain characteristics,
wounds in the mouth, eliminate body odor, stop
varying according to research objectives
bleeding gums and as a mouthwash (Moeljanto
(Saryono, 2010). In this study, the population was
and Mulyono, 2003). In addition, green betel leaf
students of the Pontianak Ministry of Health
decoction water is used to cleanse the female
Polytechnic, Midwifery Department, Midwifery
genitals. This method is proven to treat the vagina
DIII Study Program, 44 people. The sampling
and avoid vaginal discharge. The content of
technique in this study uses the total population,
phenol (carvacrol) and phenylpropane (eugenol
so the entire population is used as a respondent of
and kavikol) in essential oils of green betel leaf
44 people.
serves as an antiseptic (bactericide and fungicide)
Data collection method is a way for
which is very strong (Maytasari, 2010).
researchers to collect data to be carried out in
Based on the midwife's competency
research (Hidayat, 2007). The data used in this
standard (2011) the 6th midwife's competency
study is primary data, namely data collected
area on health promotion and counseling is
directly by researchers from the object under study
helping women recognize and maintain their
(Sunyanto, 2012). Data collection techniques in
reproductive health conditions. The role of a

*Author Correspondence
Email Address : [email protected]
this study are experimental observations. In the the same group and in the ratio scale (Dharma,
treatment group, daily water was given 500 ml of 2015). Statistical test results are used to determine
betel leaf decoction every day, which was used whether the hypothesis testing decision is
during the afternoon. Before being given the accepted. With the provision Ha is accepted if the
treatment of giving water decoction of betel leaf is value of p <0.005 and Ho is rejected if the p value>
examined the vaginal pH level. After treatment, a 0.005. If Ha is accepted, there is an effect of green
re-examination of the vaginal pH level was betel leaf decoction on vaginal pH.
conducted to determine the difference in vaginal
pH levels before and after being given a decoction RESULT AND DISCUSSION
of green betel leaf which had been given for 3
days, without using other cleansers. Result
The instrument used in this study is a Characteristics of respondents based on
measuring instrument for vaginal pH (pH respondent's age and underwear change frequency
Indicator) strips, SOP for green betel leaf water from table 3.1 are as follows:
decoction, master table, and check-list sheet, Table 3.1
based on variables that will be known difference Distribution of Respondents Based on Age of
in vaginal pH levels before and after being given Respondents and Underwear Change
water stew green betel leaf. The observation Frequency
format is done by every 1strip pH Indicator placed Respondent N Median SD Min Max
on the vaginal secretions and leave it for 120 Characteristics
Age 44 19,00 1,002 17 21
seconds, then see the color changes on thestrip pH
Indicator, and compare the colors obtained with Underwear 44 3,00 0,788 2 5
Change Freq
the pH level in the pH indicator tube.
Data analysis techniques are divided into
two types, namely, univariate analysis techniques Based on table 3.1, it can be seen that the
and bivariate analysis. Univariate analysis carried midpoint of the characteristics of respondents
out on each variable from the results of the study. based on age 19.00 with, with a minimum value of
This analysis produces the frequency distribution 17 and maximum 21 and a standard deviation of
and percentage of each variable. Univariate 1.002, while the frequency of changing underwear
analysis in this study was used to see the with a middle value of 3 00 with a minimum of 2
distribution and presentation of the dependent and maximum 5 and a standard deviation of 0.788.
variable namely the level of vaginal pH before and This univariate analysis technique is to
after being given a decoction of green betel leaf. see how each variable is illustrated in the study,
This research analysis is based on the while in this study is the vaginal pH level before
characteristics of respondents who have a regular and after being given green betel leaf decoction
diet, which is 3 times a day with the same food (Piper betle L) on the Level 1 Midwifery D-III
menu, water used for daily activities (bathing, student of the Ministry of Health Poltekkes
cebok, etc.) has the same water source, has an Pontianak in 2018. analysis to determine the
education level the same, and during cebok using differences in vaginal pH levels before and after
water boiled water or green betel for 3 days in a being given decoction of water or green betel can
row, the respondent did not use ingredients or be seen in table 3.2 are as follows:
products to clean the vagina of other brands. This
method of using a boiled water of green betel leaf Table 3.2
is used once a day at night before going to sleep, Distribution of Respondents Based on Vaginal
and is repeated for 3 days. Ph Levels Before and After Giving Green
Bivariate analysis techniques are used to Betel Leaf Decoction
compare and distinguish two variables. This study
was conducted to compare vaginal pH levels Vaginal N Median SD Min Max
pH
before and after the administration of green betel
Before 44 4,00 0,438 4 5
leaf decoction water to young women. The
statistical test used is a paired t-test with After 44 3,00 0,438 3 4
computerized assistance. This test is used to test
thedifference median of 2 measurement results in

*Author Correspondence
Email Address : [email protected]
 Based on table 3.2, it can be seen that the betel leaf. The difference in the vaginal pH
midpoint of vaginal pH before being given boiled level of the respondents before and after being
water of betel leaf 4.00 with a pH level of at least given a decoction of green betel leaf is 1,
4 and a maximum of 5 and a standard deviation of indicating that there is a difference in the
0.438, whereas after being given a decoction of average vaginal pH level of young women in
betel leaves the middle value of vaginal pH is 3.00 the Midwifery Dormitory of the Ministry of
with a minimum pH level of 3 and maximum 4 and Health Poltekkes Pontianak before and after
a standard deviation of 0.438. being given a decoction of green betel leaf
After a bivariate analysis, normality of the which shows the influence of decoction green
vaginal pH data was tested before and after being betel leaf water against vaginal pH levels.
given a decoction of betel leaf water, as listed in
Table 3.3. Discussion
Table 3.3 This study examines differences in
Statistics Distribution Normality Test vaginal pH levels before and after being given a
decoction of green betel leaf. The way the tools
No Variable Shapiro- Wilk and materials used to cleanse the female intimate
organs both externally and internally greatly affect
P
N
the vaginal condition. The use of tools and
1. pH Before Intervention 0,000 materials that are not in accordance with the
44 condition of the reproductive organs results in
2. pH After 44 0,000 many complaints occurring in the female
Intervention reproductive organs, and most often is vaginal
discharge. Normally, vaginal pH is between 3.8
Based on table 3.3 above shows the results and 4.2 (Syahlani, 2013). This means the vagina is
of the normality test that is p = 0.001 which means acidic. This number must be maintained so as not
the data is not normally distributed. Because the too low or vice versa to be higher. If the vaginal
data is not normally distributed, the analysis test pH is not balanced, mold and bacteria as a cause
uses the Wilcoxon test (Dahlan, 2014). of vaginal problems will multiply rapidly. This
situation can cause a variety of health problems in
Effect of Decoction vaginal pH levels the vagina which are characterized by vaginal
The betel leaf water decoction toresults of discharge.
bivariate analysis to see differences in vaginal pH Vaginal acidity has long been considered
levels before and after being given betel leaves as one of the vaginal protective mechanisms. Soft
decoction in young women can be seen from table vaginal healthy acidity has been shown to
3.4. correlate with a reduced risk of chlamydia,
Table 3.4 trichomoniasis, urinary tract infections, and
Differences in Vaginal Ph Levels Based on infection with genital mycoplasma and decreased
Wilcoxon Test bacterial transport in the introitus (Boskey, 2013).
The pH balance of the vagina is acidic, to prevent
No Variable Median Diff P infection, the acidic environment created by
1. pH Level 4,00 bacteria occurs normally. A healthy vagina
produces fluid to cleanse and regulate itself,
Before 1 0,000 similar to saliva which cleanses and regulates the
2. pH Level 3,00 oral environment (Nurwijaya, 2009).
After According to Dechcare (2013) there are
*uji Wilcoxon several factors that cause an imbalance in the
vaginal ecosystem, including oral contraception,
Test the analysis in table 3.4 using the diabetes mellitus, antibiotic use, menstrual blood,
Wilcoxon test, get the middle value before the spraying fluid into the vagina (douching),
vaginal pH before being given water decoction hormone disorders (puberty, menapouse, or
of green betel leaf 4.00, and the middle value pregnancy).
after being given a decoction of 3.00 green According to Bahari (2012) stated that in
general, vaginal discharge can be caused by

*Author Correspondence
Email Address : [email protected]
several factors, namely lack of attention to the The results of analysis for differences in
cleanliness of the female organs, washing the vaginal pH levels before and after being given a
female organs in the wrong direction, very tiring decoction of green betel leaf showed that there
physical activity, not immediately changing pads was a decrease in vaginal pH levels after being
when menstruation, unhealthy lifestyle, given a decoction of betel leaf water on young
psychiatric conditions that are experiencing severe women in the Midwifery Boarding Office of the
stress, using cleansing soap to excessively cleanse Ministry of Health of Pontianak. The results of this
the female organs, weather conditions especially study are also in line with Maytasari's research
humid weather, unbalanced hormonal conditions, (2010) entitled "Differences in Anti-Fungi Effect
often scratching the female organs and wearing of Essential Oils of Green Betel Leaves (Piper
tight underwear from synthetic materials. Betle L), Essential Oils of Red Betel Leaves (Piper
The number of trigger factors that cause Crocatum) and V-Resilient Syrup Soap on In
vaginal discharge so that the availability of drugs Growth of Candida Albicans Vitro "results of the
both pharmacologically and non- study showed that based on the mean diameter of
pharmacologically are used to treat vaginal the obstacle zone, it was found that green betel
discharge. Betel leaf is a non-pharmacological essential oil at all concentrations resulted in the
treatment, betel leaves contain essential oils up to largest inhibition zone compared to Flukanazol
4% (consisting of hydroxycavikol, kavikol, 25μg of red betel, and V-betel essential oil on the
estragol, methyl eugenol, karvakrol, terpenes, growth of Candida albicans in vitro. (Quasi
sesquiterpenes). Tannins, diastases, sugars and Experimental Design), that the decoction of green
starches and kavibetol, allypyrokatecol, eugenol, betel leaf is used to cleanse the female genitals,
eugenol methyl ether, p-cymene, cineole, proven to be able to treat the vagina and avoid
csriophyllene, estragol, terpenene, sesquiterpene, vaginal discharge. The content of phenol
phenyl, propane (Mursito, 2015). (karvacrol) and phenylpropane (eugenol and
According to Carolia and Noventi (2016) kavikol) in essential oils of green betel leaf serves
the mechanism of phenol as an antibacterial agent as an antiseptic (bactericidal and fungicidal)
acts as a toxin in protoplasm, damaging and which is very strong.
penetrating walls and precipitating bacterial cell The results of this study showed the mean
proteins. The main components of astari oil value of vaginal pH before administration of 4.00
consist of betle phenol and some of its derivatives green betel leaf decoction, and the middle value
including euganol allypyrocatechine 26.8- 42.5%, after giving 3.00 green betel leaf decoction.
cineol 2,4-4,8%, mehyl euganol 4,2-15,8%, Decreasing the level of vaginal pH before and
caryophyllen 3-9,8 %, hydroxy kavikol, kavikol after being given a decoction of green betel leaf is
7,2-16,7%, kabivetol 2,7-6,2%, estragol, 1 pH.
ilypryrokatecol 9,6%, karvacol 2,2-5,6%, Based on the results of statistics using the
alkaloids, flavonoids, triterpenoids or steroids , Wilcoxon test obtained p value <0.05, concluded
saponin, terpene, phenylpropane, terpinene, Ha was accepted and Ho was rejected. This shows
diastase 0.8-1.8%, and tannin 1-1.3%. At that there is a difference in vaginal pH levels
concentrations of 0.1-1% phenol are before and after being given a decoction of betel
bacteriostatic, while at concentrations of 1-2% leaf water on young women in the Midwifery
phenol are bacteriocide. Dormitory of the Ministry of Health Poltekkes
Based on the results of research conducted Pontianak, namely the average value of vaginal
on 44 young women in the Midwifery Dormitory pH after being given a decoction of betel leaf
of the Ministry of Health Poltekkes Pontianak, water lower than before being given a betel green
obtained the distribution of vaginal pH levels leaf decoction.
before using leaf decoction green betel, which is a
minimum pH level of 4, a maximum of 5, the CONCLUSION AND RECOMMENDATION
middle value of vaginal pH is 4.00 and a standard
deviation of 0.438. Distribution of bagina pH Conclusion
levels after using green betel leaf decoction, Based on the results of research
showed a minimum pH level of 3, a maximum of conducted on the effect of green betel leaf water
4, a middle value of pH of 3.00, and a standard decoction on vaginal pH levels in adolescent girls
deviation of 0.438. in the Midwifery Dormitory of the Ministry of

*Author Correspondence
Email Address : [email protected]
Health Poltekkes Pontianak, it was obtained as Dharma, K.K.2015. Metodologi Penelitian
follows: Keperawatan Pelaksanaan
1. Vaginal pH levels before being given green Melaksanakan Dan Menerapkan Hasil
betel leaf decoction (Piper Betle L ) of 4.00. Penelitian. Jakarta: Trans Indo Media.
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decrease in pH levels to become more acidic. Dan Perilaku Menjaga Kebersihan
Genitalia Eksterna Dengan Kejadian
Recommendation Keputihan Pada Siswi Sma Negeri 4
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