Health Counseling and Provision of Betel Leaves to Reduce Physiological Leucorrhea among Adolescent Girls

: In Indonesia, 75% of women have experienced vaginal discharge at least once, and half have experienced vaginal discharge twice or more. Vaginal discharge is a classic problem for most women. Ironically, most women do not know about vaginal discharge and the causes of vaginal discharge. If not handled properly, vaginal discharge can be fatal. Infertility and ectopic pregnancy (pregnancy outside the womb) can be one of the consequences of vaginal discharge. The early symptoms of uterine cancer usually start with vaginal discharge. This study's betel leaf (Piper betel Linn) belongs to the Peiperaceae family. The part used is the leaves. Betel leaf contains essential oils with compounds that have strong antibacterial properties, referred to as "kavikol" and "kavibetol". Anti-bacterial is also found in boiled betel in water. Betel leaf in traditional medicine is usually used for first aid in first-line treatment in daily medicine, especially as an antiseptic. This activity aims to increase young women's knowledge about the dangers of vaginal discharge and provide intervention in betel leaf boiled water to reduce physiological vaginal discharge. The activity results showed benefits for adolescents as evidenced by the decrease in the incidence of physiological vaginal discharge after being given counseling and betel leaf water.


INTRODUCTION
One of the reproductive health problems in adolescents is a vaginal discharge or Flour Albus (Astuti et al., 2018). According to the World Health Organization (WHO), health problems regarding poor female reproduction have reached 33% of the total burden of diseases affecting women worldwide. This figure is greater than reproductive problems in men, which only reach 12.3% at the same age as women (Wright, Schieve, Renold & Jeng, 2005). The cause of leucorrhea, according to WHO, based on its prevalence, is 25% -50% candidiasis, 20-40% bacterial vaginosis, and 5% -15% trichomoniasis. The weather factor that causes vaginal discharge in Europe is only 25%.
Factors that cause vaginal discharge are fungi, bacteria, and parasites; increased vaginal discharge is also caused by women's behavior in maintaining genital hygiene (Firmanila, Dewi & Kristiani, 2016 (Firmanila et al., 2016). Based on data from the National Population and Family Planning Agency (BKKBN) in 2012, in Indonesia, as many as 75% of women have experienced vaginal discharge at least once and 45% of them usually experience vaginal discharge twice or more. In Indonesia, Central Maluku is an area with a tropical climate which causes the skin to be prone to sweating, thus making the vaginal condition moist. High humidity causes heat in the female area and irritates the vagina, so bacteria easily multiply (Abrori, 2017).
Leucorrhea is a classic problem for most women. Ironically, most women don't know about vaginal discharge and the causes of vaginal discharge. If not handled properly, vaginal discharge can be fatal; infertility and ectopic pregnancy (pregnancy outside the womb) can be one of the results of vaginal discharge. Early symptoms of uterine cancer usually start with vaginal discharge (Gunardi & Susilo, 2021). Factors supporting the cause of vaginal discharge are physiological (normal) and pathological (abnormal) factors. Physiological factors (normal) vaginal discharge is influenced by ovulation before menstruation, sexual arousal, and emotions.
Meanwhile, pathological factors (abnormal) are caused by infection, bacteria, parasites, fungi, trichomonas vaginalis virus, vaginal bacteria, syphilis, and candida albicans gonorrhea (Andayani et al., 2017). Factors that trigger the development of the candida albicans fungus include body temperature that changes according to the cycle; it could also be due to food, especially sugar and carbohydrates, or the use of unsuitable soap products, and not keeping the genital area clean.
Candida albicans are a member of the normal flora on the skin, mucous membranes, and digestive tract (Brooks, 2005in Maytasari, 2010. The community is doing much to reduce the occurrence of leucorrhoea, including pharmacologically (medicines from doctors) and non-pharmacologically, such as through changes in behavior, personal hygiene, and psychology, and consuming herbal products that are trusted for their efficacy. Using natural ingredients as herbal medicines is considered safer because the side effects are more harmless to the body than modern medicines (Dewi, 2014). One of the plants often used as an alternative to reduce leucorrhoea is betel leaf; in addition to many around the house, green betel leaf is often used because of the risk of harmless side effects. In general, the content of betel leaves has active chemical compounds such as polyphenols, alkaloids, steroids, saponins, and tannins (Handayani, 2017). This study's betel leaf (Piper betel Linn) belongs to the Peiperaceae tribe. The part used is the leaves. Inside the betel leaf is an essential oil containing compounds with strong antibacterial properties, known as "kavikol" and "kavibetol". The anti-bacterial is also found in betel leaf in water. Betel leaves in traditional medicine are usually used for first aid in daily medicine, especially as an antiseptic (Koensoemardiyah, 2010).
This community service activity is planned to be carried out at Muhammadiyah Mamala High School because from the results of a preliminary study in the form of interviews conducted on December 7, 2021, by researchers, it was found that 10 students interviewed experienced vaginal discharge, 6 of the students who experienced vaginal discharge resolved it by using soap or certain products to female area purchased from shops or stalls around the residence, and 4 of the female students who experienced vaginal discharge did not take any treatment because they thought vaginal discharge was a normal thing for women. In addition, 10 of the students interviewed had known that betel leaf had properties for treating leucorrhea but had never tried it. This activity is important because the health of the female reproductive organs is the main thing that must be considered; besides that, herbal treatment is considered more economical and rarely causes side effects. This research was conducted at SMA Muhammadiyah Mamala because it is the only school in Mamala village. This activity is also intended as a preventive and promotive effort in utilizing and developing plants as herbal medicine.
elderly farmers is carried out by asking elderly farmers to explain the action plans to be taken to improve Adaptive Coping. The material delivered to sugar cane farmers is a Mental Health Media Kit titled "Maintaining Our Mental Health" from the Ministry of Health of the Republic of Indonesia (Kemenkes RI. 2017). The community service activity ended with the distribution of groceries to sugarcane farmers.
The selection of the location for the implementation of Community Service was determined based on the interests of Muhammadiyah Mamala High School in July 2022. The form of this service activity is lecturing and giving betel leaves to make a decoction and use for vulva hygiene in order to reduce complaints due to physiological changes in adolescents, namely vaginal discharge. The tools needed to make betel leaf boiled water and provide counseling include presentation tools (notebook, LCD), papers/brochures, banners, camera, leaflets, betel leaf, water, filter, pot, and stove. How to process red betel leaves: 1. Prepare 7-10 pieces of fresh betel leaves.
2. Put the betel leaves into the pot and then add the 2.5 liters of water provided.
3. Boil betel leaves over medium heat until boiling.
4. The boiled betel leaves are allowed to warm, then filtered. In warm conditions, boiled water is given to the respondent to wash the female area. Based on Table 1, it was found that the average value of leucorrhea experienced before being given treatment was 12.93, with a standard deviation of 1.680. After being given treatment 2 times a day a week, the average value of vaginal discharge experienced was 7.90 with a standard deviation of 1.845. by using a non-parametric test, which was Wilcoxon with a p-value=0.000 at α=5%, which means that the p < α, and it can be concluded that there is an effect in giving betel leaf boiled water on leucorrhea in female students.

RESULT AND DISCUSSION
Leucorrhea or flour albus is a vaginal condition when germs cause discharge or mucus resembling pus. Sometimes vaginal discharge can itch, smell bad, and have a greenish color (Karaz overcoming nosebleeds, burns, asthma, throat infections, bronchitis, and leucorrhea (Suparni & Wulandari, 2012). This research was conducted by giving betel leaf boiled water twice a day by washing the female area of the respondent, namely in the morning at 07.00 WIB and the afternoon at 17.00 WIB for one week. Betel leaf decoction was prepared and provided by the researchers themselves so that all respondents received the same betel leaf boiled water treatment with the same dosage and method of boiling without any difference. The betel leaves used in this study were obtained from one place so that the composition and types of betel leaves did not vary.
Research by Sari (2011) in the Work Area of the Umban Sari Health Center, Pekanbaru, concluded that there was a significant difference in the change in vaginal discharge values in the experimental group after being given betel leaf decoction by washing the female area three times a day for a week, the difference was that the research researchers have done at the Poltekkes Kemenkes Riau campus not using a control group and giving betel leaf boiled water is by drinking.
The dosage and method of processing betel leaf boiled water also have differences, the characteristics and place of the respondents in the study and the time of administration of betel leaf boiled water which is given twice a day for one week.
Based on the explanation above, the researcher assumes that betel leaf affects leucorrhea, good for preventing, reducing, or treating leucorrhea. This is because betel leaf contains essential oils useful as antifungal, antiseptic and reduce vaginal secretions. The researcher's suggestion is for respondents who have been exposed to be able to apply and inform about the benefits of betel leaf boiled water. For research sites to become information material and input in overcoming leucorrhea, it is necessary to find out what percentage of betel leaf extract is effective against leucorrhea and other factors that cause leucorrhea. Overall, the benefits of this activity were felt by teenagers, especially counseling about reproductive health. They admit that they have never received information on properly caring for the reproductive organs to avoid disease.

CONCLUSION AND SUGGESTION
There is an effect of giving betel leaf boiled water to reduce physiological vaginal discharge in young women. Young women admitted that this activity was very useful in counseling about reproductive health and interventions by giving betel leaf boiled water. The results of this activity are expected to provide information or input for schools to continue to increase adolescents' knowledge about reproductive health through outreach activities at schools or in collaboration with local health centers.

ACKNOWLEDGEMENT
Universitas Nasional funded this program.