Use Of Panty Liner As A Risk Factor The Occurration Of Abnormal Vaginal Discharge

Vaginal discharge or fluor albus is a problem that is often found in women. Daily use of panty liner is a predisposing factor of pathological/abnormal vaginal discharge. This paper reviews the correlation between the use of panty liner and vaginal discharge. The aims of this study were to analyze the effect of daily panty liner use as a risk factor of vaginal discharge. This research is done by using the cross-sectional method. The study population is students of the University of Pelita Harapan in the Faculty of  Nursery. Sample size calculation was done using the categorical comparative analytical formula and a result of 46 samples were obtained for each population. A questionnaire was used in this research. Statistical analysis is done by using the SPSS 22.0 program with the Chi-Square method. Bivariate analysis on 92 respondents revealed that there is a significant association between the usage of a panty liner and abnormal vaginal discharge (p-value <0.05). Based on bivariate analysis panty liner material is not related to abnormal vaginal discharge (p-value >0.05).


Introduction
One of the factors that affect health problems in the female reproductive organs is abnormal vaginal discharge. Discharge that comes from a woman's genitalia outside the menstrual period and is not in the form of blood is called vaginal discharge or fluor albus. 1 Vaginal discharge can be both physiological and pathological. Vaginal discharge is said to be physiological if it is odorless, colorless/ whitish, and does not feel itchy. A vaginal discharge is said to be pathological if the discharge becomes yellowish, itchy, and foul-smelling. 2 Women of all ages can experience vaginal discharge-.Women aged 15-24 years experienced vaginal discharge as much as 3l.8% according to a survey conducted by the Indonesian Adolescent Reproductive Health Survey (SKRRI). Based on the results of research on women's reproductive health, 75% of women in the world have experienced vaginal discharge and 45% of them experience recurrent vaginal discharge. 2 The prevalence of vaginal discharge often increased, in 2002, 50% of women experienced vaginal discharge. In 2003 this figure increased to 60% and to 70% in 2004. 3 This increase in percentage was due to the tropical climate in Indonesia. This condition causes the feminine area to become moist so that the fungus can easily develop and cause vaginal discharge. 4 Abnormal vaginal discharge can be caused by infection or non-infection. Non-infectious causes that can cause vaginal discharge include abnormalities of the reproductive organs that can be caused by tumors or malignancy. There are also factors that trigger vaginal discharge, such as diabetes, urinary tract infections, use of contraceptive pills and use of panty liners. 5,6 Indonesian women still think that the use of panty liners can protect their feminine area. 7 In fact, the use of panty liners can make the use of panty liners moist and can cause vaginal discharge. Based on research by Farage (2007), 10-30% of women in North America and Western Europe always use panty liners outside of their menstrual period, this is based on their desire to keep their female area clean and dry .8 However, there is no data that states the percentage of panty liner users in Indonesia. The panty liner does not have a significant difference with ordinary pads, what distinguishes the two is the size of the panty liner which is thinner than ordinary pads. 9 In addition, according to research by Farage (2007), the use of panty liners can reduce the number of Lactobacillus species which are normal flora in the vagina, and can increase the number of bad bacteria in the vagina, namely Eubacterium species. The use of panty liners can also cause intestinal flora such as Eschericia coli to enter the vagina. 9 Research that has been conducted at the Faculty of Medicine, University of Andalas Padang (UNAND) and Aisyiyah University Yogyakarta, the use of panty liners can trigger vaginal discharge. It is stated that there is a relationship between the use of panty liners and the incidence of vaginal discharge (69.2%). 10 The results of research conducted by Aisyiyah University Health Sciences Yogyakarta also showed 56% of women who use panty liners experience vaginal discharge. 6 According to the International Journal of Gynecology & Obstetrics, from four studies on the use of panty liners, there was no effect on the appearance of vaginal discharge, only one study supported the influence between the use of panty liners and vaginal discharge. 11 Another journal research conducted by the International Journal of Gynecology & Obstetrics, also stated that 95% of women who use panty liners do not experience problems with vaginal discharge. 12 There are still pro and contra regarding this problem, so further research is needed to prove the effect between the two.

Research Design and Sample
This research was conducted with a quantitative analytic research type with cross sectional method with case control. The sample size estimation of this study was calculated using unpaired categorical comparative analytic method. The total sample required in this study was 92 people. In this study, samples that use panty liners and those who do not use panty liners are needed. The inclusion criteria in this study included female students of the Faculty of Nursing, Pelita Harapan University, 18-25 years. Subjects with Diabetes Mellitus and organic reproductive organ disorders (uterine tumors) were excluded.

Data and Statistical Analysis
Data obtained using primary data, where data is taken directly through questionnaires The data obtained from the study will be tabulated and analyzed.data tabulation will be performed using Microsoft Excel 2010 program and data analysis will be performed using SPSS 22.0 program. Statistical tests are conducted to prove the hypothesis. The method used for normal distribution is Chi2. The method for abnormal distribution will be analyzed using Fisher's Test

Leviana Aurellia
29| U n i v e r s i t y o f P e l i t a H a r a p an

Results and Discussion
Characteristics of Research Subjects: The age distribution in the majority of panty liner users is 20 years old, as many as 22 people. Then followed by the age of 19 years, totaling 11 people. A total of ten respondents were 2l years old and there were three respondents who were 18 years old. There were no respondents aged 22 years who used panty liners (Table 1). For the age distribution in the non-wearing panty liner group, it was found that the majority of respondents were 19 years old as many as 18 respondents. 16 respondents aged 20 years and eight respondents aged 2l years. There are two respondents aged 18 years and also two respondents aged 22 years (Table 2). Data from research results that have been statistically tested with Chi Square, obtained a P value of 0.001 where the P value is less than 0.05. This has a positive meaning, so it can be concluded that the use of panty liners can be a risk factor for abnormal vaginal discharge (Table 3). Respondents without abnormal discharge in non-panty liners more than those with panty liners as many as 35 respondents. A total of 17 respondents did not have abnormal vaginal discharge even when using panty liners. Two respondents used panty liners containing antiseptic and 44 respondents used panty liners without antiseptics (Table  5). In this study it can be said that the bias is quite large. This is due to many confounding factors, including cleanliness vulva, stress, Sexually Transmitted Diseases, wearing tights, and antiseptic. Vulvar hygiene itself includes the direction of cleaning the area femininity, drying of the feminine area, the number of pads used at the time menstruation, underwear material, and number of underwear changes.

Conclusion
In this study, it is known that the use of panty liners can increase the risk of vaginal discharge. It can be seen that the incidence of vaginal discharge in female students who use panty liners is 76% o. The rate of vaginal discharge in female students who did not wear panty liners but vaginal discharge was 24%. Using panty liners can cause vaginal discharge five times greater than not using panty liners. However, the type of panty liner did not have a significant relationship with the occurrence of vaginal discharge.