MODUL 4

KEPUTIHAN
BLOK REPRODUKSI
Tutor : dr. Inna Muthmainnah
Musa
KELOMPOK 3
• Widya Islamiyah Tahir (11020170036)
• Farhah Ayunizar Ramadani (11020170047)
• Mardika Intan Setya Putri Laode (11020170060)
• Muhammad Fakhri (11020170069)
• Sri Ainun Zainal Siddiq (11020170081)
• Siti Alzavira Chairunnisa (11020170095)
• Andi Muhammad Nasywan Akbar (11020170106)
• Wa Ode Nur Fatimah Rifaat (11020170118)
• Muhammad Fajri Irfan (11020170127)
• Muhammad Imran Jumaide (11020170135)
SKENARIO
A 40 years old woman, P6A0 came to the
primary health care with chief complain of white
discharge, fluidic consistency and bad odor with
pain occasionally felt. There’s history of post coital
bleeding. These condition often felt repeatedly in
the last 2 year.
DIFFICULT WORD
-
Key Word
1. A 40 years old woman
2. P6A0
3. Complain of white discharge,
4. Fluidic consistency
5. Bad odor with pain occasionally felt
6. History of post coital bleeding
7. These condition often felt repeatedly in the last 2
year
Question
1. What is the definition and the classification of
white discharge and etiology of white
discharge ?
2. How the pathomechanism of the symptoms
based on the scenario ?
3. What is the risk factor of white discharge ?
4. What is the step of diagnosis in this scenario ?
5. What is the differential diagnosis in this
scenario ?
6. What is the islam perspective ?
What is the defenition of white
discharge ?

Fluor albus (leucorrhoea, leukorrhea, vaginal

discharge) is a term used for fluids that come out of a
woman's genitalia that are not in the form of blood.
Leucorrhoea is a condition that is often experienced by
women through out their life cycle starting from
adolescence, reproduction and menopause.

Referensi: -Persia, A. Gustia, R. Bahar, E. 2015. Hubungan Pemakaian Panty Liner dengan Kejadian
Fluor Albus pada Siswi SMA di Kota Padang Berdasarkan Wawancara Terpimpin (Kuisioner). Padang:
Jurnal Kesehatan Andalas. Halaman 509.
-Marhaeni, G.A. 2016. Keputihan Pada Wanita. Denpasar: Jurnal Skala Husada Vol 13 No 1. Halaman 30.
-Abrori, Hernawan A.D, Ermulyadi. 2017. Faktor Yang Berhubungan Dengan Kejadian Keputihan
Patologis Siswi SMAN 1 Simpang Hilir:
 Classification and etiology of
white discharge
PHYSIOLOGIC PATHOLOGIC
AL AL

lot of exudate fluid which

many epithelium with rare contains many leukocytes, strong
leukocytes, odourless, clear or smell, changes in colour, with
whitish in color, itching, burning a rash or
soreness

caused by microorganism infections

such as fungi (Candida Albikan),
influenced by hormonal changes
parasites (Trichomonas), and parasites
(sexual arousal, days 10-16 of the (E.Coli, Staphylococcus, Treponema
menstrual cycle, when stimulated, Pallidum). Fluor Albus can also be
pregnant, tired, stressed and caused by foreign bodies, benign
: - Badaryati, Emi. 2012. Faktor-Faktor Yang Mempengaruhi Perilaku
taking
Pencegahan hormonal
dan drugs
Penanganan Keputihan Patologis such
Pada Siswi as
Slta atau
Sederajat di Kota Banjarbaru Tahun 2012. Depok: FKM UI. Halaman
neoplasms, lesions, precancerous, and
birth- Jawetz,
10. control pills. malignant neoplasms.
Melnick, Adelberg. Mikrobiologi Kedokteran. Edisi 25. EGC:
Jakarta
The symtomps in the scenario are complain
white discharge, fluidic consistency, bad
odor with pain.

It means the symtomps belongs to

pathological leucorrhea because white
discharge with
bad odor commonly caused by bacteria or
candida.
And there is no pain in the physiological
leucorrhea.
 Leucorrhoea mechanism

Pathogenic Immune
Leucorrho pathologic norma microorganisms system
ea al that
l flora change the pH of
the vagina works

Torcia M. 2019. Interplay among Vaginal Microbiome, Immune Response and Sexually Transmitted Viral Infections. Department of Clinical and
Experimental Medicine, University of Firenze, 50139 Firenze, Italy; Halaman 1 - 2
Causes of postcoital bleeding based
On scenario:

Friction and Small tears and

Abrasio of cuts sensitive
intercourse genital tissue
Postcoital
bleeding
Inflammation
Infection Of Vaginal
Tissues

: Wan, Y. L., Edmondson, R. J., & Crosbie, E. J. (2015, April 1).

Intermenstrual and postcoital bleeding. Obstetrics, Gynaecology and
Reproductive Medicine, 25(4), 106–112
 Amino Byby bacterial anaerob
Acid + facultative vaginal
bacteria

OOd IRRITATION + RELEASE OF

EPITHELIAL CELLS
or

DUH COMES OUT OF THE VAGINA

 What is the risk factor of white discharge ?
• Predisposing factors
 Infection factors are bacteria, fungi, parasites, and viruses.
 Non-infections namely:
The entry of foreign objects into the vagina both intentionally or
unintentionally which can injure the vaginal epithelium,
The area around the vagina is moist,
Stressful body conditions, such as those that are always tense or anxious,
Restrain urination,
Poor or improper personal hygiene
• Risk factors (characteristics, habits, signs or symptoms that appear in a person
or population before developing a disease)
 The habit of not maintaining proper hygiene of the reproductive organs
 Attitudes (behaviors) in maintaining genital hygiene
 Environment, in the hot tropics causing excessive expenditure of sweat
 Douching is an action to wash or clean the vagina with water or a mixture
consisting of water, vinegar, baking soda and iodine
Based on the scenario, the risk factor caused by infection post coital
bleeding, because there's history of post coital bleeding
Referensi : Elmia Kursani, H. M. (2015). Faktor-faktor YangMempengaruhi Terjadinya Flour
Albus (Keputihan) Pada Remaja Putridi SMA PGRI Pekanbaru Tahun 2013. Jurnal Maternity
and Neonatal Volume 2 No 1, 31.
 What is the step of diagnosis in this scenario ?

History
• Identity : a 40 years old woman
• Main Complain : White discharge,fluidy consistency and bad odor with pain
occasionally felt
• Since when the symptomps are felt ?

Taking
• Sexual activity history : Post coital bleeding
• Asking if there is itching
• Habit & contraception history

Physical
Examinat
• Inspection
• Palpation
• Vagina Touche, Speculum

ion
Laborator • Vagina pH test
• Gram staining

y Checks
• Culture
• Serological examination

Reference: Ramayanti. Pola Mikroorganisme Fluor Albus Patologis yang Disebabkan Oleh Infeksi pada
Penderita Rawat Jalan di Klinik Ginekologi Rumah Sakit Umum Dr. Kariadi Semarang. Bagian Obstetri &
Ginekologi Fakultas Kedokteran Universitas Diponegoro. Diakses pada 31 Maret 2019:
http://eprints.undip.ac.id/12387/1/2004PPDS3634.pdf.
 What is the differential diagnosis in this scenario ?

DD -> TRIKOMONI BACTERIAL KANKER CERVICITIS

ASIS VAGINOSIS SERVIKS

Definition Trikomoniasis is a clinical Cervical cancer is Cervicitis is

syndrome due to the growth of
is an infection the substitution of abnormal cells in
inflammation
that is Lactobacillus spp. the cervical of the mucous
sexually producing tissue. Cervical membrane
transmitted hydrogen cancer is the from cervical
peroxide (H2O2) primary cancer
and obtained in normal vagina that is derived
canal.
through direct with anaerobic from the cervix
sexual bacteria namely (cervical or
contact. It can Bacteroides spp., porsio). The
Mobiluncus spp., cervix is the front
live for a few Gardnerella end of the uterus
hours in a vaginalis (G. that sticks to the
humid Vaginalis), and vagina
Mycoplasma
environment Hominis (M.
hominis).

Epidemiologi 1. Women Research in The CDC

aged 40 to Asian women estimates
49 years in Indonesia sexually
2. Women and Indonesia transmitted
DD -> TRIKOMONI BACTERIAL KANKER CERVICITIS
ASIS VAGINOSIS SERVIKS

Etiologi Tricomonas Of anaerobic more than trichomonas

bacteria is high vaginalis, candida
vaginalis 90% of and mycoplasma
concentrations, cervical or endogenous
e.g. Bacteroides
cancer is aerobic and
spp., anaerobic
Mobiluncus associated
microorganisms
spp., with human such as
Gardnerella papilloma Streptococcus
vaginalis (G. virus (HPV) vagina,
Vaginalis), and enterococus, E.
Mycoplasma coli, and
staphylococus.
hominis (M.
hominis).

Clinical 1. Seropurulen 1. Smell may occur in the

form of post-
White
t Sekret-
Symptoms mukopurulen
2. Itching sanggama discharge,
yellowish to (pruritus) hemorrhage or there usually
may also be bleeding
greenish 3. Whitish, outside of the viscous and is
yellow grayed menstrual period and usually
2. Unpleasant post-menopausal. If
smell and
out the tumor is large, odorless,
foaming 4. Dispareun infection can occur often leading
and cause fluid (duh)
3. Vaginal wall ia smelling that flows to erosion on
looks red 5. Disuria out of the vagina. the lower
"Strawberry When the disease is
DD -> TRIKOMONI BACTERIAL KANKER CERVICITIS
ASIS VAGINOSIS SERVIKS
1. Microscopy Criterion Amsel
1. Vaginal
Screaning Clinical
Diagnostic test
Diagnosis for wet discharge: white with HPV Test, examination:
preparations.
Grey pH Vagina :
>4,8
PAP test and Inspekulo
2. Diamond 2. whiff test : fishy Visual acetate cervix
modification odor inspection Laboratory
Media, for 3. Microscope
example In Examination: (IVA) examination:
Pouch TV Clue cells with Pap Smear
attached kokoid
bacteria, no
leukocytes.
4. KU: Vaginal
discharge, bad
smell (maybe
add bad after
intercourse),
possibly itching.

Treatment 1. Metronidazo Non-Pharmacology: 1. Krioterapi 1. Antibiotics

1. Maintaining self- 2. immersion in
le: Single hygiene 2. Elektrokau
dose 2 10% AgNO3
especially the ter and irrigation.
grams per vaginal area
2. Avoid the use of 3. Electrocoa 3. ectropion do
day for 7 lastic or
days
soap to clean gu lation
the vaginal area amputation.
2. Nimorazol: 3. Keep your 4. Laser 4. AgNO3 10%
weight Ideal
Single dose Pharmacology:
or Albothyl
2 grams a. Metronidazol 3 x 5. road-radial
3. Omidazol: 500mg per day with
DD -> TRIKOMONI BACTERIAL KANKER CERVICITIS
ASIS VAGINOSIS SERVIKS
Prevention 1. Tell patients 1. Vaksin HPV cancer can be
about safe done with the
sexual
2. Condom program and the
practices use screening of
2. The patient 3. Circumcisi vaccination. In
should also on in men developed
refrain from countries, this
sexual
4. No kind of cancer
intercourse smoking cases has begun
until the 5. Consumpti to decline thanks
patient and his on of to the program of
partner are early detection
treated, and nutritious through Pap
the symptoms foods smears.
have been lost
3. A revisit for
Referensi:
follow-up
1. Sarwono Prawirohardjo, Prof, dr, on Wiknjosastro, Prof, dr, DSOG; Ilmu Kandungan, YBP-SP,Edisi ke dua, estacan ke tiga, FKUI,
DSOG dan Hanifa
Yakarta; 1999, Hal 271 -27-2. the 7th day
2. Robbins L., M.D; Buku Ajar Patologi II, Edisi ke empat, cetakan pertama. Penerbit Buku Kedokteran EGC,Jakarta; 1995, Hal. 372-377.3.
3. Bagian Obstetri dan Ginekologi, 1981. Ginekologi. Bandung: Fakultas Kedokteran Universitas Padjajaran Bandung
4. Fahmi Syaiful Daili, Nilasari Hanny. 2019. Ilmu Penyakit Kulit dan Kelamin. Edisi Ketujuh: Jakarta. Fakultas Kedokteran Universitas Indonesia. Hal
450-451.
5. Schumann JA, Plasner S. Trichomoniasis. [Updated 2019 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2020Jan.Availablefrom:https://www.ncbi.nlm.nih.gov/books/NBK534826
6. Saleh AM, Abdalla HS, Satti AB, Babiker SM, Gasim GI, Adam I. Diagnosis of Trichomonous vaginalis by microscopy, latex agglutination, diamond's
media, and PCR in symptomatic women, Khartoum, Sudan. Diagn Pathol. 2014;9:49. Published 2014 Mar 6. doi:10.1186/1746-1596-9-49
7. Buku Pedoman Nasional Tatalaksna IMS. 2016. Kementerian Kesehatan Republik Indonesia8/2/2016 3:26:37 PM 8/2/2016 3:26:37
8. Soedarto. Buku Ajar Kedokteran Tropis Handbook Of Tropical Medicine. 2018. Penerbit : Sagung Seto
9. Persia, A. Gustia, R. Bahar, E. 2015. Hubungan Pemakaian Panty Liner dengan Kejadian Fluor Albus pada Siswi SMA di Kota Padang Berdasarkan
Wawancara Terpimpin (Kuisioner). Padang: Jurnal Kesehatan Andalas. Halaman 509.
10. Marhaeni, G.A. 2016. Keputihan Pada Wanita. Denpasar: Jurnal Skala Husada Vol 13 No 1. Halaman 30.
11. Laras. 2009. Analisa Faktor Kanker Serviks. Lontar Fakultas Kedokteran Universitas Indonseia. Hal 6-19
12. Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet 2011; 378: 1461–1484.
13. Wiknjosastro, H. 2006. Ilmu Kandungan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo
Symptoms Of Differential Diagnosis Based On The
Scenario: BACTERIAL
VAGINOSIS
SYMPTOMS TRICOMONIA
CA CERVIX CERVICITIS
SIS
- Complain +
of white
+ + +
discharge
,
-
- Fluidic
- -
consisten +
cy +

- Bad odor +
- +
with pain +

- occasiona + - -
lly felt
-
- History of
+ +
post coital -
bleeding
What is the islam perspective ?

in the Bukhari saheeh it is stated that a

Friend named Ummu ‘Athiyyah
radhiallahu‘anha said:
ُّ ‫كُنَّا اَل نَعُد ُّ الْكُد ْ َرةَ وَال‬
َ َ‫صف َْرة‬
‫شيْئ‬
"We do not consider al-kudrah (turbid liquid)
and as-sufrah (yellowish liquid) the same as
menstruation"
THANK YOU