Keputihan pada Perempuan

KEPUTIHAN (leukorea, white discharge, fluor albus) adalah gejala penyakit yang ditandai oleh
keluarnya cairan dari organ reproduksi, dan bukan berupa darah. Keputihan merupakan salah
satu alasan yang paling sering mengapa perempuan memeriksakan diri ke dokter, khususnya
dokter ahli kebidanan dan penyakit kandungan. Dapat dibedakan antara keputihan yang normal
dan yang tidak normal. Keputihan normal ditemukan pada :
* Bayi yang baru lahir sampai umur kira-kira 10 hari, yaitu akibat pengaruh hormon estrogen ibu
terhadap rahim dan vagina janin, saat janin masih di dalam kandungan;
* Saat mengalami haid yang pertama kali; keputihan akan hilang sendiri, akan tetapi dapat
menimbulkan keresahan pada orang tuanya;
* Perempuan dewasa apabila ia dirangsang waktu senggama, akibat pengaruh transudasi dari
dinding vagina;
* Masa subur perempuan; karena kadar hormon estrogen meningkat;
* Penderita penyakit menahun dengan kelainan jiwa neurosis.

Penyebab paling sering dari keputihan tidak normal ialah infeksi. Di sini cairan mengandung
banyak sel darah putih dan warnanya agak kekuning-kuningan sampai hijau, sering kali lebih
kental dan berbau. Organ perempuan yang dapat terkena infeksi adalah vulva, vagina, leher
rahim, dan rongga rahim. Infeksi ini dapat disebabkan oleh :
(1). Kuman (bakteri). Gonococcus, yaitu penyakit kelamin, nanah berwarna kekuningan (sel
darah putih yang mengandung kuman Neisseria gonorrhoea, pasangan dua-dua dalam
sitoplasma sel). Chlamydia trachomatis, sering menyebabkan penyakit mata trakhoma.
Gardnerella Vaginalis, yang menyebabkan peradangan vagina tak spesifik, biasanya mengisi
penuh sel-sel epitel vagina membentuk bentuk khas clue cell. Ini menghasilkan asam amino yang
akan diubah menjadi senyawa amin bau amis, berwarna ke abu-abuan. Treponema pallidum,
penyebab penyakit kelamin sifilis. Sering ditandai adanya penyakit jengger ayam di kemaluan.
(2). Jamur, dari spesies kandida. Cairannya kental, berwarna putih susu (sering berbentuk
kepala susu), gatal. Vagina kemerahan akibat radang. Penyakit jamur banyak terjadi pada
kehamilan, kencing manis, menopause, kegemukan, akseptor pil KB.
(3). Parasit, dengan penyebab keputihan terbanyak adalah Trichomonas vaginalis. Cairannya
banyak, berbuih seperti air sabun dan bau, tidak terlalu gatal, vulva kemerahan, nyeri bila
ditekan atau perih bila buang air kecil. Pada anak-anak bisa disebabkan karena parasit lain
seperti Enterobiasis, gatal sering digaruk sampai luka.
(4). Virus. ini sering disebabkan oleh Human Papilloma Virus (HPV) dan Herpes Simpleks. HPV
sering ditandai dengan kondiloma akuminata/ tumbuhan seperti jengger ayam, cairan berbau,
tanpa rasa gatal. Gambaran klinis lebih buruk bila disertai gangguan sistem kekebalan tubuh
seperti: kehamilan, pemakaian kontikosteroid jangka lama dan AIDS.

Penyebab lain dari keputihan selain infeksi adalah :
(1). Kelainan alat kelamin didapat atau bawaan. Adanya fistel vesikovaginalis atau adanya
saluran yang menghubungkan kandung kemih dan vagina atau adanya saluran yang
menghubungkan antara rektum dan vagina, akibat cedera persalinan, operasi pengangkatan
rahim, radiasi pada kanker organ reproduksi atau akibat kanker itu sendiri.
(2). Benda Asing. Terjadi akibat kotoran tanah atau biji-bijian pada anak-anak atau tertinggalnya
kondom atau benda lain yang dipakai waktu senggama, atau akibat karet pengganjal yang
digunakan untuk mencegah rahim turun.
(3). Kanker. Keputihan juga ditemukan pada tumor ganas. Sel tumbuh sangat cepat secara
abnormal dan mudah rusak, akibatnya terjadi pembusukan dan perdarahan. Cairan banyak, bau
busuk, sering disertai darah tak segar.
(4). Menopause. Pada menopause sel-sel dan vagina mengalami hambatan dalam pematangan
sel akibat tidak adanya hormon pemacu, estrogen. Vagina kering, sering timbul rasa gatal karena
tipisnya lapisan sel sehingga mudah luka dan timbul infeksi penyerta.

Bila keputihan tidak segera diobati akan timbul penyakit radang panggul yang berlarut-larut dan
dapat menyebabkan kemandulan (infertilitas) karena kerusakan dan tersumbatnya saluran telur.
Dilaporkan juga bahwa keputihan pada kehamilan dapat menyebabkan persalinan prematur dan

bahan spermisidal. sebaiknya selalu periksakan ke dokter. Yakinlah untuk memeriksa secara teratur setidaknya satu kali setiap tiga tahun. Kadang-kadang gejala tidak begitu jelas sampai semua terlambat. Berhenti merokok karena penelitian menemukan hubungan antara merokok dan kanker vulva dan gunakan kondom. douche. * Agar tidak terjadi infeksi dari mikroorganisme yang berasal dari anus/dubur dianjurkan untuk cebok dari arah depan ke arah belakang. * Pengobatan infeksi juga diberikan kepada suami. karena kulit yang lembab/ basah dapat menimbulkan iritasi dan memudahkan tumbuhnya jamur dan kuman penyakit. dokter akan menyarankan untuk test lab. untuk menghindari fenomena ping-pong atau kambuh-kambuhan. * Mencuci alat kelamin bagian luar cukup dengan air dan sabun mandi biasa saja. banyak wanita menghindari pergi ke dokter padahal penghindaran ini dapat mempengaruhi kesehatan serius termasuk kesuburan. Karena masih ada stigma mengenai kesehatan seksual. masalah hormonal atau penyakit yang disebakan hubungan seksual (STD). Segera periksa ke dokter jika anda menemukan gejala itu.kelahiran bayi dengan berat lahir rendah. Kiat menjaga kebersihan alat kelamin luar pada perempuan * Menjaga kebersihan alat kelamin luar pada perempuan sangat penting dalam upaya mencegah timbulnya keputihan dan juga mencegah Penyakit Menular Seksual (PMS). Upaya pencegahan PID adalah lakukan seks yang aman dan memeriksakan secara teratur. Ini penting untuk mengetahui gejala yang ditimbulkan dan juga untuk mendapatkan informasi mengenai masalah kesehatan seksual yang banyak wanita hadapi. bagaimana mencegahnya dan bagaimana melindungi diri. atau bahan lain yang dimasukkan ke dalam vagina dapat mengakibatkan alergi dan iritasi pada vagina sehingga dapat juga timbul keputihan. Penyakit ini dapat dengan mudah disembuhkan dengan antibiotik. Keadaan ini dapat dicapai dengan mengeringkan kulit dengan handuk atau tisu bila berkeringat atau setelah buang air. · PID Pelvic Inflammatory Disease (PID) mempangaruhi satu dari 10 wanita dan jika dibiarkan akan menyebabkan ketidaksuburan. * Pemakaian deodoran.* Bacaan FKUI catatan kuliah ginekologi obstetri !!! Jika anda diduga memiliki masalah yang berhubungan dengan penyakit kewanitaan apakah itu periode mentsruasi yang tidak teratur. · BV . * Terlalu sering melakukan douche (mencuci/membilas) vagina dengan larutan antiseptik dapat merugikan. Kulit daerah alat kelamin dan sekitarnya harus diusahakan agar tetap bersih dan kering. karena akan menghilangkan cairan vagina yang normal dan dapat mematikan bakteri alamiah di dalam vagina. Suatu keputihan yang tidak sembuh dengan pengobatan biasa (antibiotik dan anti-jamur) harus dipikirkan keputihan tersebut disebabkan oleh suatu penyakit keganasan seperti kanker leher rahim. Sebagian besar penyakit ini tidak begitu berbahaya tetapi jika test smear nampak tidak normal. Berikut beberapa penyakit umum yang wanita hadapi dan cara menjamin kesehatan kewanitaan tetap sehat: · HPV Human papillomavirus (HPV) adalah salah satu infeksi virus yang disebabkan oleh hubungan seksual paling umum. pendarahy ang tidak teratur atau perubahan bau pada vagina. Keadaan ini akan lebih merangsang pengeluaran cairan vagina. Gejala yang mungkin timbul pinggul sakit saat hubungan seks. Cara untuk mengatetahui HPV adalah dengan cervical smear atau screening kesehatan seksual.

disrupt the vagina’s normal flora. diaphragms. Gardneralla mobiluncus. metabolizes glycogen to lactic acid in the vagina and maintains normal vaginal pH. Jika dibiarkan. itching. Vaginal fluid may be treated with a 10% solution of potassium hydroxide (KOH). as oral (pill) or topical (cream) treatments. contraceptive sponges. Sex partners may require treatment if infection recurs. overused or retained tampons. and pH levels are checked. Gardnerella vaginalis overwhelms healthy bacteria when the defense is weakened. When used topically. Douching. and low birth weight in infants born to infected mothers. Broad-spectrum antibiotics may destroy healthy bacteria. intrauterine contraceptive devices (IUDs). A pelvic examination is performed to determine whether the cervix is producing abnormal secretions and to check for other diseases. helpful bacteria. and products containing nonoxynol-9 may also disrupt the balance. and promote infection. it may cause a different vaginal discharge with a strange smell. Causes and Risk Factors BV is caused by a change in the natural balance of bacteria in the vagina. ini akan meningkat resiko berkembang menjadi PID Gardnerella vaginalis Overview Bacterial vaginosis (BV) is characterized by the overgrowth of certain bacteria in the vagina. Diagnosis Diagnosis is usually made by visual observation and by smell. Gejala dari ketidakseimbangan bakteri dalam vagina termasuk gatal. A sample is usually taken for microscopic examination to confirm the presence of bacteria. Bacterial vaginosis also is associated with having multiple sex partners. premature birth. itching. sticky. Penyakit ini sering dianggap hanya infeksi karena memiliki gejala yang sangat umum dengan infeksi biasa. If too much gardnerella grows. Douching should be avoided. Elevated vaginal pH level is also a symptom. aroma amis dan perubahan dalam vagina. It may be accompanied by a smooth. Treatment Antibiotics such as metronidazole and clindamycin are generally prescribed. Most physicians recommend a full STD screening. including Gardnerella vaginalis. and irritation. GARDNERELLA What is gardnerella? Gardnerella is a bacteria. which provides a natural defense against unhealthy bacteria proliferation. but do not develop infection. . these medications may cause side effects such as stinging. and irritation. Jangan biarkan gejala-gejala tersebut dan yakinlah untuk diperiksa dan disembuhkan dengan baik. white or gray discharge 4 days to 4 weeks following exposure. and Mycoplasma hominis. particularly those who are sexually active. ectopic (tubal) pregnancy. a new monogamous sexual relationship. infertility. Aboout 50% of women have Gardnerella vaginalis in their vaginal flora.Bacterial vaginosis adalah salah satu infeksi vagina yang paling umum diantara wanita diusia beranak. and irritation are common signs of BV and may be particularly noticeable after intercourse or menses. It accounts for 60% of vulvovaginal infections and causes vaginal and vulvar pain. Young adult women. which makes the characteristic odor more pronounced. are most commonly affected. Bacterial vaginosis is grossly underdiagnosed because many women assume they have a yeast infection and treat symptoms with over-the-counter medications. burning. Lacotbacillus. Normally. it grows in small amounts in a woman’s vagina and rectum. and a history of STDs. Signs and Symptoms A fishy vaginal odor. Complications BV is associated with pelvic inflammatory disease (PID).

Lactobacillus (the bacteria found in yogurt) can help control the symptoms. The infection can be treated by taking a medication by mouth. bacteria belonging mostly to the Lactobacillus family live harmlessly in the vagina and produce chemicals that keep the vaginal environment mildly acidic. bath oils. · Avoid douching. Bacterial vaginosis has been implicated as a risk factor for premature labor and delivery. Bacterial vaginosis commonly is diagnosed during pregnancy. This is why pregnant women may be checked for bacterial vaginosis even when they have no symptoms. premature rupture of membranes and postpartum uterine infections. · Change out of your wet bathing suit or sweaty exercise clothes as soon as possible. Symptoms . It’s better not to wear underwear when you sleep. Scientists do not fully understand the reason behind the change in concentration of vaginal bacteria that causes bacterial vaginosis. bacterial vaginosis is simply a nuisance. How do you prevent a gardnerella infection? · Always wipe yourself from front to back after going to the bathroom · Do not use deodorant tampons or pads. but they are not harmful. You can buy these lactobacillus yogurt capsules at the health food store. Under normal circumstances. · Wear loose fitting pants. Bacterial vaginosis is the most common cause of abnormal vaginal odor and discharge. Do you need a follow-up test? If you feel better. these normal Lactobacillus bacteria are replaced by other types of bacteria that normally are present in smaller concentrations in the vagina. How can you tell if you have a gardnerella infection? If you have a gardnerella infection. the use of vaginal contraceptive product that contains the chemical nonoxynol-9 and frequent vaginal douching. You should keep them in the fridge. Men: · No symptoms. Men are not usually treated for gardnerella. In bacterial vaginosis.Gardnerella infections can be uncomfortable. and the goal of treatment is to relieve symptoms. For most women. perfumed soaps. You only need to treat a gardnerella infection if the symptoms are bothering you. Men are not usually tested for gardnerella infections. Women can be treated with prescription drugs such as flagyl or clindamycin. You can put one or two yogurt capsules in your vagina before bedtime for one week. or by inserting a medicated cream into the vagina. · Discharge from your vagina that smells like fish. How is a gardnerella infection treated? Gardnerella in your vagina is not harmful. · Wear cotton underwear during the day. This shift in bacterial population away from Lactobacillus results in bacterial vaginosis. you might notice: Women: · Discharge from your vagina that is white or grey. Risk factors that seem to increase the likelihood of bacterial vaginosis include a history of multiple sex partners. Bacterial Vaginosis (Gardnerella Vaginitis) What Is It? Bacterial vaginosis is a gynecological condition caused by a change in the type of bacteria found in the vagina. How do you get tested for a gardnerella infection? A doctor or nurse can test you by looking at the discharge from your vagina or by taking a swab from your vagina. a sexual relationship with a new partner. you don’t need another test. or feminine hygiene sprays.

pelvic. these symptoms are especially bothersome during or after intercourse. Scientists currently have no explanation for why some women have problems with recurrent infection. There is no perfect test. bacterial vaginosis is considered by some to be sexually transmitted. your doctor will check for other possible causes. Your doctor can diagnose bacterial vaginosis based on the results of a gynecological examination and laboratory tests of your vaginal fluid. methods of contraception and pregnancy history. oral preparations are the preferred treatment. and personal-hygiene issues such as douching history and your use of feminine deodorants. dilation and curettage (D&C). Either can be taken by mouth or applied as a vaginal cream or gel. The U. IUD insertion. bacterial vaginosis also occurs in people who either are not sexually active or have been in long-term monogamous relationships. Prevention Doctors are not exactly sure why bacterial vaginosis develops. there is a 98-percent chance that you have bacterial vaginosis: · White. history of sexually transmitted infection and pelvic infection.5) · Fishy odor when a sample of your vaginal discharge is combined with a drop of potassium hydroxide on a glass slide (the "whiff test") · Clue cells (vaginal skin cells that are coated with bacteria) visible on microscopic exam of your vaginal fluid Your doctor also may order other laboratory tests to rule out other causes of vaginal discharge. Routinely screening all women for bacterial vaginosis is not recommended. Centers for Disease Control and Prevention currently recommends that all pregnant women with symptoms should be treated with oral medications because they are safe and work better than vaginal preparations. . Treatment Doctors commonly treat bacterial vaginosis using medications. having bacterial vaginosis may make it easier for you to be infected with HIV if your sexual partner has HIV. Your doctor also may ask if you have any other diseases. number of sex partners. such as diabetes. hysterosalpingogram (utero- tubogram). Bacterial vaginosis has been associated with uterine. previous vaginal or urinary-tract infections. The white discharge seen in bacterial vaginosis tends to have a thinner consistency than the "cheesy. However. Because it occurs more commonly in people who are sexually active. According to experts. Options include metronidazole (MetroGel-Vaginal) or clindamycin (Cleocin). and vaginal-cuff infection in women who have had certain procedures such as endometrial biopsy. Diagnosis In addition to asking you to describe the vaginal odor and discharge. However. If you already have HIV.Up to 50 percent of women diagnosed with bacterial vaginosis do not have symptoms.S. women who undergo certain hospital or office-based surgical procedures may be treated if infection is identified. Pregnant women who are at high risk of preterm labor and delivery should be tested for bacterial vaginosis and receive treatment even if symptoms are absent. it causes an unpleasant vaginal odor and a white vaginal discharge. For some women. but if you have three of the following four criteria. However. then the presence of bacterial vaginosis may increase the chance that you will spread HIV to your sexual partner. your doctor will ask you about your menstrual history (last menstrual period). tightly fitting undergarments and tampons. thin. So if you have these symptoms. Significant irritation of the vulva or pain with intercourse is uncommon with bacterial vaginosis. Treatment of male sex partners doesn't necessarily prevent re-infections in women who have had bacterial vaginosis. hysterectomy and Caesarean section. but in some cases treating the male partner may be helpful." thick discharge seen in vaginal yeast (Candida) infections. or if you have used antibiotics recently. coating on your vaginal walls during the pelvic exam · pH test of your vaginal discharge that shows low acidity (pH greater than 4. In others.

Keputihan alami : . Repeat episodes of bacterial vaginosis occur. kehamilan.wanita dewasa : masa subur.tidak meninggalkan noda pada pakaian dalam .meningkat selama kehamilan . tidak encer. but they often improve with re-treatment. especially if you are pregnant.5) . Bacaan FKUI catatan kuliah ginekologi obstetri !!! Keadaan normal vagina .meningkat akibat pengaruh hormonal .meningkat pada masa sesaat sebelum / sesudah haid . doctors do not recommend any routine treatment for the male sex partners of women who have bacterial vaginosis. akseptor KB .anak wanita pada awal pubertas / menarche .menopause : vaginitis senilis Radang vulva / vagina berdasarkan penyebab Bacterial vaginosis (BV) Disebut juga vaginitis nonspesifik.sekresi normal à konsistensi "flokuler" à kental.flora dominan aerobik.bayi wanita baru lahir . tidak lengket . produksi lactobacillus . Prognosis Studies show that a seven-day treatment with oral metronidazole or a five-day treatment with metronidazole vaginal gel is equally effective in non-pregnant women.Currently.warna keputihan jernih .tidak berbau .terdapat komunitas flora normal vagina (Candida albicans dalam keadaan normal ditemukan pada 30-50% vagina dan serviks). Ciri keputihan normal : . seolah tersembunyi di forniks posterior Keputihan (leucorrhea / fluor albus) Adanya cairan yang keluar dari vagina. and clindamycin vaginal cream is slightly less effective than either preparation of metronidazole. vaginitis gardnerella .pH normal asam (< 4.jumlah sekresi sedikit.meningkat setelah sanggama .meningkat saat ovulasi (dapat sebagai tanda deteksi) .tidak lama . When To Call A Professional Call your doctor whenever you notice any abnormal vaginal odor or discharge.

3) pH > 4. .penyakit radang panggul . 2) sekret warna abu-abu keruh. misalnya sanggama sering. Peningkatan faktor risiko BV : .sitologi abnormal .Dipengaruhi proses alkalinisasi vagina.klindamisin krim 2% aplikasi intravaginal malam hari selama 7 hari .ketuban pecah dini. korioamnionitis . pemakaian obat pencuci vagina (vaginal douche).5 Terapi BV : .metronidazol 2 x 500mg oral (7 hari) atau dosis tunggal 2 g oral.kehamilan .endometritis pasca sectio cesarea Diagnosis BV : 1) sekret berbau amis.pascaaborsi .