VULVA HYGIENE

(Submitted to fulfill one of the English course assignments)

Arranged by:

Devia Amelin Setiawan (1420122019)

Ika Dwi Partika (1420122036)
Rosamanda Ester Imkorle (1420122051)
Romauli Manalu (1420122047)
Windaningsih (1420122037)

STUDY PROGRAM S-1 NURSING A

INSTITUTE OF HEALTH IMMANUEL BANDUNG

2023
 PREFACE
All praise and gratitude of the author for the presence of Allah swt, the Lord of the
entire universe and its contents. With His permission and grace the author was able to
complete an English paper entitled "vulva hygiene" in a timely manner. Not to forget the
shalawat and greetings the author dedicate to the beloved of Allah, the noblest man
Muhammad SAW. May his intercession flow to all of us in the last day.

The purpose of writing a paper entitled "Vulva Hygiene" is to fulfill one of the
assignments of the English course. During the process of preparing the paper the author
received some support and help from several parties. Therefore, the author is grateful to.

1. Mrs. Amanda Puspanditaning Sejati, S.Pd., M.Hum. Is true as a lecturer in English courses
who has helped the drafting team in learning.

2. Colleagues in group 1 who have worked well together as a team so that this paper can be
completed on time.

With humility, the author apologizes if there are any mismatches in sentences and
errors. The author realizes the paper created is far from perfect. Therefore, the author is very
open to receiving criticism and suggestions from readers for the perfection of the paper. The
author hopes that this paper will be useful to various parties. Amiin.

Bandung, 3 January 2023

Drafting Team
 TABLE OF CONTENTS

PREFACE...................................................................................................................................i

TABLE OF CONTENTS.........................................................................................................ii

CHAPTER I INTRODUCTION.............................................................................................3

I.I. Background......................................................................................................................3

I.II. Writing Purpose...............................................Kesalahan! Bookmark tidak ditentukan.

I.II.I General Purpose........................................Kesalahan! Bookmark tidak ditentukan.

I.II.II Special Purpose.......................................................................................................4

I.III. Formulation Of The Problem.....................................................................................4

I.IV. Writing System.............................................................................................................4

CHAPTER II BASE OF THEORY.........................................................................................6

II.I. Physiology Of The Vulvovaginal Area........................................................................6

II.II. Anatomy Of The Vulva...............................................................................................6

II.III. Vulvovaginal Infection.............................................................................................10

II.IV. Protection The Vulva from Infections....................................................................10

II.V. Intimate Feminime Hygine.......................................................................................10

II.VI. Tips For Vulva Care.................................................................................................11

CHAPTER III CLOSING......................................................................................................13

III.I. Conclusion..................................................................................................................13

BIBLIOGRAPHY...................................................................................................................14
 CHAPTER I
INTRODUCTION
I.I. Background
Reproductive health according to the World Health Organization (WHO)
(2011) is a condition of physical, mental, and social well-being full, not just free from
an illness or associated disability with its reproductive system, functions and
processes. Healthcare process reproduction needs to pay attention to several things,
including knowledge, attitudes, and skills. It is important for young women to
maintain organ health reproduction in particular by carrying out hygiene vulva
treatment (Azizah, Hidayah, & Rahman, 2014). Vulva hygiene is an action to
keep the intimate organs clean outer (vulva) to avoid infection and maintain health
(Achjar, 2010). Good hygiene vulva treatment can reduce the risk the occurrence of
vaginal discharge. Vaginal discharge is discharge except for blood from vaginal
opening that smells fishy, even pungent and causes a taste itching and heat in the
female area (Kusmiran, 2011). Vaginal discharge is twofold, i.e. physiological and
pathological discharge. Physiological discharge is vaginal discharge that occurs
between the time before and after menstruation, where the cells in the cervix and
vagina will secrete mucus that sticky. While pathological discharge is a discharge
caused due to disease, usually caused due to infection from bacteria, fungi or protozoa
(Aizid, 2012). Pathological discharge can lead to a lack of self-confidence and
discomfort (Bubakar, Amiruddin, & Monalisa, 2012).

The incidence of vaginal discharge in the world in women is around 75% and
75% of women in Indonesia experience vaginal discharge at least once during her
lifetime and 45% of women experience vaginal discharge twice or more (Bubakar,
Amiruddin, & Monalisa, 2012). Research results shows that in 2009 in Central
Java there were 2.9 million young women aged 15 – 24 years, 45% experience vaginal
discharge and in in 2010 it increased to 3.1 million inhabitants. Research results from
Dinkes Demak Regency, there were 29.8% (26,797) of adolescents who experienced
an incident vaginal discharge (Dinkes Jateng, 2010).
I.II. Writing Purpose
I.II.I General Purpose
The purpose of this writing is to find out how to take care of the cleanliness of
the reproductive apparatus.

I.II.II Special Purpose

1. To know to care for the reproductive apparatus

2. To know how important it is to keep the reproductive apparatus clean.

3. To know the benefits ot the vulva hygine.

4. To find out disorders and infections of the reproductive apparatus.

5. To know part of the vulva.

I.III. Formulation Of The Problem

1. How to treat the vulva hygine?

2. How important is it to maintain the health of the reproductive apparatus?

3. What are the benefits of keeping the reproductive apparatus clean?

4. How disorders and infections occur if they do not maintain the cleanliness of the
reproductive apparatus?

I.IV. Writing System

PREFACE

TABLE OF CONTENTS

CHAPTER I INTRODUCTION

I.I Background

1.II Purpose Of Writing

I.II.I General Purpose

I.II.II Special Purpose

I.III Formulation Of The Problem

I.IV Writing System

CHAPTER II BASE OF THEORY

II.I. Physiology Of The Vulvovaginal Area

II.II. Anatomy Of The Vulva

II.III. Vulvovaginal Infection

II.IV. Protection The Vulva From Infections

II.V. Intimate Feminine Hygiene

II.VI. Tips For Vulva Care

CHAPTER III CONCLUSION

III.I Conclusion

BIBLIOGRAPHY
 CHAPTER II
BASE OF THEORY
II.I. Physiology Of The Vulvovaginal Area
Vulva hygiene is cleaning the vulva and the surrounding area in female
patients who are in the puerperium or unable to do it alone. Vulva hygiene also aims
to prevent infection, for healing of perineal suture wounds and for perineal hygiene
(Timbawa, 2015). The goals of perineal care are to remove perineal secretions, to
prevent and alleviate infection, and to provide comfort. Vulvar skin differs from other
skin sites in hydration, friction, permeability, and visually discernible irritation and is
more susceptible to topical agents than forearm skin because of its increased
hydration, occlusion, and frictional properties. The non-keratinized vulvar vestibule is
likely to be more permeable than keratinized skin. Genital skin is unique in that it is
covered by a thin stratum corneum containing large hair follicles, making it easier for
microbial and other substances to permeate the skin. The vagina is the fibromuscular
canal extending from its external opening in the vulva to the cervix and is composed
mainly of smooth muscle covered with a non-keratinized epithelial lining, which, until
the menopause, is thick, with folds kept moist by fluid secreted through the vaginal
wall and mucus from cervical and vestibular glands.

II.II. Anatomy Of The Vulva

a. Mons Pubis
The mons pubis is an inverted triangular area of fatty tissue covered with hair-
bearing skin overlying the anterior aspect of the pubic bone. It extends from the glans
clitoris inferiorly to the pubic hairline (the base of this triangle). The primary
 composition of the mons pubis is adipose tissue overlying fascia, which is a
continuation of the Camper and Scarpa fascia from the anterior abdominal wall. The
average length of the base is reported as 16 cm, and the average height of the triangle
is 13 cm.
b. Labia Majora
The labia majora (labium, singular) are prominent paired cutaneous lateral folds
of hair bearing skin and adipose tissue that extend inferiorly from the mons pubis and
merge with neighboring skin to form a ridge overlying the perineal body, also known
as the posterior fourchette. Besides adipose tissue, they also contain the distal ends of
the round ligaments, hair follicles, and a rich supply of sebaceous, apocrine, and
eccrine sweat glands. The lateral surfaces of the lips of the labia majora in the adult
are covered with pigmented skin containing many glands and pubic hair, while the
insides remain smooth, pink, and hairless.
Labia majora resemble the anterior abdominal wall in their underlying
composition: Camper’s fascia with a predominance of fat which is superficially
located. The thicker Colles fascia forms the deeper layer and corresponds to the
Scarpa fascia in the abdominal wall. The Colles fascia is inferiorly attached to the
ischiopubic rami and posteriorly to the urogenital diaphragm, but lacks anterior
attachments; this may be clinically significant, because hematomas and infections are
is unable to extend to the thigh region, but may travel to the anterior abdominal wall.
The average length of the labia majora from the most superior aspect of the clitoral
hood to the posterior fourchette ranges between 7 and 12 cm.
c. Labia Minora
The labia minora are pigmented, hairless folds of skin, devoid of fat, but rich in
nerve endings and sensory receptors. They are located medial to the labia major
immediately adjacent to the vestibule. Anteriorly, each separates into 2 folds that run
over and under the glans of the clitoris. The superior folds unite in the midline to form
the prepuce, or clitoral hood. The inferior folds insert into the underside of the clitoris
to form the frenulum. The posterior aspects of both labia minora merge with the labia
majora at the posterior fourchette. The Hart line demarcates the transition between the
keratinized epithelium of the labia minora (embryologically deriving from the
ectoderm) and the nonkeratinized epithelium of the vestibule of the vagina
(embryologically deriving from the endoderm).
 The dermis of the labia minora is composed of thick connective tissue containing
elastic fibers and small blood vessels. The arrangement of the blood vessels forms
erectile tissue similar to the penile corpus spongiosum.The labia minora are highly
innervated along their entire edge, allowing detection of patterns at a very fine scale.
A recent study has shown characteristic staining patterns of free nerve endings,
Meissner corpuscles, and Pacinian corpuscles in the labia minora. Because of these
innervation patterns, they may play a role in sexual sensation and arousal. Further
more, due to the termination of the labia minora at the clitoral hood, any traction or
manipulation of the labia may stimulate the clitoris. This movement could contribute
to sexual function and may be reduced following labial revision.MRI studies of female
organs during sexual arousal have demonstrated specific changes to the width of labia
minora corresponding with their erectile behavior.
There is a large variation in the dimensions of the labia minora; average length
ranges from 2 to 10 cm, measured from the frenulum of the clitoris to the posterior
fourchette, while the width varies from 0.7 to 5 cm, extending laterally from the
hymen.They may be asymmetrical or even duplicated on one or both sides.In some
African populations, labia minora have been stretched to 20 cm, while in Western
societies today labiaplasty has been increasing in popularity.
d. Vestibule
The vestibule of the vagina includes the area between the hymen and Hart line
laterally, the frenulum of the clitoris anteriorly, and the posterior fourchette
posteriorly. It contains the vaginal orifice, external urethral meatus, clitoral bulbs, the
openings of the 2 greater vestibular (Bartholin) glands, and those of numerous,
mucous, lesser vestibular glands.The area between the frenulum of the clitoris and the
external urethral meatus where the clitoral bulbs join together anteriorly is the female
corpus spongiosum or pars intermedia. The area between the hymen and posterior
fourchette is the fossa navicularis. The external urethral meatus is located within the
vestibule of the vagina superior to the vaginal opening. Two paraurethral Skene glands
are located at the posterior-lateral aspect of the urethral meatus, line the urethra
longitudinally, and aid in lubrication. The Bartholin glands open into the posterior-
lateral aspect of the vestibule at approximately the 5 and 7 o’clock positions. The
vestibule is an area of some significance in patients presenting with vulvar pain and
dyspareunia. Although poorly understood, patients with these conditions often
describe localized pain to the vestibule, which may occur either provoked or
 unprovoked. Patients with vulvar pain or vestibulodynia have been shown to have
higher density of nerve endings in this tissue, which could be contributory. Moreover,
the embryologic similarity with the lining of the urethra and bladder could help
explain comorbidity with painful bladder and urethral syndromes.
The hymen is a circumferential structure composed of non-hair-bearing skin. The
internal surfaces of the hymen are normally in contact with each other and the vaginal
orifice appears as a cleft between them.It is variable in shape, sometimes appearing as
a ring, at other times, a semilunar fold. Occasionally, it can even be absent. Once
ruptured, the small skin elevations found in a circumferential pattern are referred to as
hymeneal remnants. Although there is no known function to the hymen, an unruptured
hymen has cultural significance in many societies, because it is deemed proof of
virginity. Unfortunately, there is considerable variation in normal hymeneal
appearance, and this tissue can be torn during tampon usage, speculum examination,
and even athletic activity.Despite these hymenal variations, hymenorrhaphy or
hymenoplasty procedures for “revirgination” have been documented to re-create an
intact hymen. Some describe cutting a flap off the back vaginal wall and bringing it
across the vaginal opening to create “a band across the hymeneal ring,” or even
inserting a gelatin capsule containing fake blood that can burst on penetration.
e. Clitoris
The complexity of the clitoris is often neglected despite being widely accepted as
the most critical anatomic structure to female sexual arousal and orgasm. The clitoris
actually consists of 6 main components: glans, suspensory ligament, body (corpora),
root, paired crura, and vestibular bulbs. Broadly, the clitoris has external and internal
components that are embedded deep in the labia minora fat and vasculature and
inferior to the pubic arch and symphysis. The external component of the clitoris
consists of the glans, which is covered by the prepuce anteriorly and bordered by the
frenulum posteriorly. The deeper, internal structures of the clitoris are the body, paired
crura, and vestibular bulbs. Both physiologically and anatomically, however, the
clitoris has an intimate relationship with the distal urethra and vagina. The clitoris
partially encircles the distal urethra, lies below the vestibular skin, and abuts the distal
lateral vaginal walls. The term clitoral urethral complex and other variations have been
used to describe this important area. These structures share vasculature and
innervation and move in unison during sexual activity.
II.III. Vulvovaginal Infection
Vulvovaginal disease is often caused by multiple factors. Many factors, such
as immune deficiency, hormonal changes, stress, or use of a vaginal douche or soap to
clean the vagina, may upset the normal flora and cause infections. The vulva is
susceptible to dermatitis and other dermatological conditions, particularly when the
barrier function of the skin is compromised by factors that constitute the normal
vulvar environment, namely, moisture (urine, vaginal discharge), enzymes (stool
residue), friction, and heat.Vaginal infections are often known as vaginitis. The cause
of vaginitis, 70% of them are caused by bacterial vaginosis, candidiasis, and
trichomoniasis. While the remaining 30% can be caused by other factors such as
decreased estrogen. Vaginitis occurs in women who have entered the puberty phase
and will enter the menopause phase with risk factors such as lack of hygiene,
unprotected sexual intercourse with multiple partners, sexually transmitted diseases,
and others. The symptoms and characteristics of each type of vaginitis can be
distinguished based on the resulting discharge and physical condition of the vagina.

II.IV. Protection The Vulva from Infections

The normal vaginal flora, acidic vaginal pH, and vaginal discharge are all
components of the innate defense mechanisms that protect against vulvovaginal
infections. Resident bacteria help maintain an acidic pH and compete with exogenous
pathogens to adhere to the vaginal mucosa. They also fend off pathogens by producing
antimicrobial compounds, such as bacteriocin.Vaginal fluids collected from five
women showed in vitro activity againstnon-resident bacterial species, including
Escherichia coli and Group B Streptococcus. Protection against Group B
Streptococcus is particularly important for pregnant women as it often colonizes the
vagina through the gastrointestinal tract and increases the risk of preterm delivery,
neonatal meningitis, and even fetal death. It may also cause asymptomatic bacteriuria
and urinary tract infections, upper genital tract infections, and postpartum
endometritis. The importance of vaginal lactic acid needs to be emphasized as it
correlates with vaginal health, inhibits the growth of bacteria associated with bacterial
vaginosis, and possibly plays a role in The local immune defense.

II.V. Intimate Feminime Hygine

Many factors contribute to feminine hygiene practices, including personal
preference and cultural and societal influences. Although vaginal douching is common
 for many women, there are no known confirmed health benefits, and this may
undermine the innate immune defenses by altering the normal vaginal flora and
predisposing women to infections. Vaginal douching has also been associated with an
increased risk of pelvic inflammatory disease, endometriosis, and sexually transmitted
infections. In contrast, routine washing of the vulva is desirable to prevent
accumulation of vaginal discharge, sweat, urine, and fecal contamination to prevent
offensive body odor. Although vulvar cleansing may be a useful adjunct to medical
treatment, vulvar cleansing products are not designed to treat infections. There has,
however, been a surge in intimate hygiene products for cleanliness and odor control,
but some may upset pH in the vulvovaginal area, which will affect the composition of
the normal vulvovaginal microbiota needed for protection against infection.

II.VI. Tips For Vulva Care

1) Use warm water to wash the vulva. Dry thoroughly with a clean towel. (If the vulva is
very irritated, you can try drying it with a blow dryer set on cool.)
2) The vagina cleanses itself naturally in the form of normal, vaginal discharge. Avoid
using douches unless prescribed by your physician. These products can upset the
natural balance of organisms.
3) Wear only white, 100 percent cotton underwear. Avoid wearing nylon, acetate, or
other manmade fibers if you have delicate skin or are prone to vulvar irritation.
4) Avoid wearing thongs.
5) Rinse underclothes carefully after washing or double-rinse. Avoid using too much
laundry detergent.
6) Wash new underclothes before wearing.
7) Use a mild soap for washing underclothes. Avoid fabric softeners (including dryer
sheets) and detergents with enzymes (amylase, lipase, protease and cellulose).
8) Use soft toilet tissue (white only).
9) Use tampons instead of sanitary napkins to control menstrual bleeding. (Do not use
deodorant tampons.) Do not leave tampons in for a long period, due to toxic shock
syndrome. Do not leave tampons in all night.
10) Take sitz baths daily, if prescribed by your healthcare provider.
11) Avoid wearing nylon pantyhose or panty girdles. They trap heat and moisture,
providing an ideal breeding environment for organisms. When nylons or leggings are
required, wear cotton or nylons with a cotton panty.
12) Avoid these feminine hygiene products, which can irritate the vulva: sanitary pads,
feminine spray and deodorants, scented oils, bubble baths, bath oils, talc or powder.
 CHAPTER III
CLOSING
III.I. Conclusion
Vulva hygiene is one of the measures to maintain the cleanliness of the outer
female organ (Vulva) which is carried out to maintain health and prevent infection.
Conducting vulva hygiene is highly recommended so that the genitals are always in a
clean state. If it is clean, then the reproductive tract can be ensured to have good
health. One of the impacts of not doing vulva hygiene correctly is that vaginal
discharge will appear. Throughout her life women are thought to have experienced
vaginal discharge at least once, these whitish attacks are commonly experienced by
women of productive age. One of the benefits of vulva hygiene is that it keeps the
vagina clean and comfortable and can also prevent the appearance of vaginal
discharge, itching, and unpleasant odors.
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