Health Counseling and Cervical Cancer Screening Test for Reproductive Age Women in Bojong Gede District

: In Indonesia, 75% of women have experienced vaginal discharge at least once in their lives and half of them 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. The betel leaf (Piper betle linn) used in this study belongs to the Peiperaceae family. The part used is the leaves. Betel leaf contains essential oils that contain compounds that have strong antibacterial properties, which are 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 the knowledge of adolescent girls about the dangers of vaginal discharge and provide an intervention in the form of betel leaf boiled water to reduce physiological vaginal discharge. The results of the activity 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 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 leucorrhoea, 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).In Indonesia alone, 75% of women have experienced vaginal discharge at least once in their life and half of them have experienced vaginal discharge twice or more.This is related to the humid weather which makes it easier for Indonesian women to experience leucorrhoea, where the humid weather can facilitate fungal development.Many incidents of vaginal discharge are caused by the Candidiosis Vulvavaginitis bacteria because many women do not know how to clean their vaginal area; other causes are Bacterial Vaginitis and Trichomonas Vaginalis (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 in their life, 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 that bacteria quickly multiply (Abrori, 2017).
Meanwhile, pathological factors (abnormal) are caused by infection, bacteria, parasites, fungi and 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 is a member of the normal flora on the skin, mucous membranes, and digestive tract (Brooks, 2005in Maytasari 2010).
Many are being done by the community to reduce the occurrence of leucorrhoea, including pharmacologically (medicines from doctors), non-pharmacologically such as: changes in behavior, personal hygiene, psychology, and consuming herbal products that are trusted for their efficacy.The use of natural ingredients as herbal medicines is considered safer, because the side effects are harmless to the body than modern medicines (Dewi, 2014).One of the plants that is 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).The betel leaf (Piper betle linn) used in this study belongs to the Peiperaceae tribe.The part used is the leaves.Inside the betel leaf there is an essential oil which contains compounds that have strong antibacterial properties, which are 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 total number of students who were interviewed had known that betel leaf had properties for treating leucorrhoea, 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 the utilization and development of plants as herbal medicine.

IMPLEMENTATION METHOD
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: 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 and 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-value < α, and it can be concluded that there is an effect in giving betel leaf boiled water on leucorrhoea in female students.

RESULT AND DISCUSSION
Leucorrhoea 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 & Anderson, 2003).Betel leaf (Piper betel L) is a vine that rests on other tree trunks.Betel leaves contain an essential oil, chavikol, which causes betel leaves to have a distinctive odor and has properties to kill bacteria.This plant is useful for preventing various diseases such as diabetes, overcoming nosebleeds, burns, asthma, throat infections, bronchitis, and leucorrhoea (Suparni & Wulandari, 2012).This research was conducted by giving betel leaf boiled water twice a day by washing the female area of the respondent, which was in the morning at 07.00 and in the afternoon at 17.00 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 leucorrhoea, which is good for preventing, reducing, or treating leucorrhoea.This is because betel leaf contains essential oils which are helpful as antifungal, antiseptic and reduce vaginal secretions.The researcher's suggestion is for respondents who have been exposed to be able to apply and be informed about the benefits of betel leaf boiled water.For research sites so that they can become information material and input in overcoming leucorrhea, for further research, it is necessary to research 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 how to care for the reproductive organs properly to avoid disease.

CONCLUSION AND RECOMMENDATION
There is an effect of giving betel leaf boiled water to reduce physiological vaginal discharge among adolescent girls.

Table 1 .
The Effect of Red Betel Leaves *Wilcoxon test, α=5% Adolescent girls 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.