Main Article Content
Abstract
Purpose: This study aims to examine the risk factors contributing to abnormal vaginal discharge in adolescent girls by integrating biological, hygienic, socio-cultural, economic, and psychological determinants. Unlike previous research on hormonal influences, this study offers a comprehensive perspective on how various factors affect adolescent reproductive health.
Research Design and Methodology: This research employs a systematic literature review (SLR) approach to synthesize findings from scholarly articles published after 2018. Relevant studies were retrieved from Elsevier, Emerald, Wiley, and Springer databases. The analysis focuses on identifying dominant biological, behavioral, and environmental factors contributing to vaginal discharge among adolescent girls, along with potential interventions to mitigate health risks.
Findings and Discussion: The results indicate that hormonal fluctuations during puberty influence vaginal microbiota and secretion levels, while poor hygiene practices, lack of reproductive health education, and socio-economic constraints exacerbate infection risks. Cultural stigmas surrounding menstruation and vaginal health further hinder adolescents from seeking timely medical attention. Additionally, stress and mental health issues contribute to hormonal imbalances, increasing susceptibility to abnormal discharge. These findings emphasize the interconnectedness of physiological, behavioral, and environmental factors in adolescent reproductive health.
Implications: This study highlights the importance of comprehensive school reproductive health education, enhanced access to sanitary products, and reduced social stigmas through targeted public health campaigns. Policymakers should prioritize the affordability of sanitary products and ensure access to proper sanitation facilities, particularly in low-income communities. Future research should explore empirical approaches, including qualitative interviews and regional case studies, to further assess the lived experiences of adolescent girls in diverse cultural contexts.
Keywords
Article Details

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References
- Adolfsson, A., Hagander, A., Mahjoubipour, F., & Larsson, P.-G. (2017). How vaginal infections impact women’s everyday life: women’s lived experiences of bacterial Vaginosis and recurrent vulvovaginal candidiasis. Advances in Sexual Medicine, 7(1), 1–19. https://doi.org/10.4236/asm.2017.71001
- Akanzum, J., & Pienaah, C. K. A. (2023). Review of the effects of adequate sanitary facilities on the participation and performance of the school girl child in Ghana. ISABB Journal of Health and Environmental Sciences, 8(1), 1–14. https://doi.org/10.5897/ISAAB-JHE2021.0073
- Amabebe, E., & Anumba, D. O. C. (2018). Psychosocial stress, cortisol levels, and maintenance of vaginal health. Frontiers in Endocrinology, 9, 568. https://doi.org/10.3389/fendo.2018.00568
- Anjarsari, N., & Sari, E. P. (2020). Relationship Stress Levels with Menstrual Cycle in Adolescent Girls. Psychiatry Nursing Journal (Jurnal Keperawatan Jiwa), 2(1 SE-Articles), 1–4. https://doi.org/10.20473/pnj.v2i1.19135
- Baka, S., Demeridou, S., Kaparos, G., Tsoutsouras, K., Touloumakos, S., Dagre, M., Meretaki, S., Chasiakou, A., Koumaki, V., & Tsakris, A. (2022). Microbiological findings in prepubertal and pubertal girls with vulvovaginitis. European Journal of Pediatrics, 181(12), 4149–4155. https://doi.org/10.1007/s00431-022-04631-4
- Bin, Z., Zhi, T., Laahirie, E., G., S. M., & A., B. G. (2022). Roles of the Microbiota of the Female Reproductive Tract in Gynecological and Reproductive Health. Microbiology and Molecular Biology Reviews, 86(4), e00181-21. https://doi.org/10.1128/mmbr.00181-21
- Chen, Y., Bruning, E., Rubino, J., & Eder, S. E. (2017). Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Women’s Health, 13(3), 58–67.
- Cohn, S., & Blumberg, R. L. (2020). Poverty, Water, Sanitation Insecurities, and the Challenges of Maintaining Menstrual Hygiene. In Gender and Development: The Economic Basis of Women’s Power (pp. 119–144). SAGE Publications, Inc. https://doi.org/10.4135/9781544381190.n9
- Collins, M. K., McCutcheon, C. R., & Petroff, M. G. (2022). Impact of estrogen and progesterone on immune cells and host–pathogen interactions in the lower female reproductive tract. The Journal of Immunology, 209(8), 1437–1449. https://doi.org/10.4049/jimmunol.2200454
- Darma, M., Yusran, S., & Fachlevy, A. F. (2017). Hubungan Pengetahuan, Vulva Hygiene, Stres, dan Pola Makan dengan Kejadian Infeksi Flour Albus (Keputihan) pada Remaja Siswi SMA Negeri 6 Kendari 2017. Jurnal Ilmiah Mahasiswa Kesehatan Masyarakat Unsyiah, 2(6).
- Dorjey, Y., Wangmo, D., & Tshomo, D. (2022). Assessment of excessive vaginal discharge among women who presented to Phuentsholing General Hospital: A hospital‐based study. Health Science Reports, 5(5), e793. https://doi.org/10.1002/hsr2.793
- Eduwan, J. (2022). Gambaran Pengetahuan Tentang Keputihan Pada Remaja Putri. Jurnal Vokasi Keperawatan (JVK), 5(1), 71–77. https://doi.org/10.33369/jvk.v5i1.22449
- Girigoswami, K., Girigoswami, A., Harini, A., & Thanujashree, J. (2024). Knowledge on female hygiene and its associated diseases: a mini review. Arab Gulf Journal of Scientific Research, 42(3), 1117–1129. https://doi.org/10.1108/AGJSR-02-2023-0074
- Hanifah, H., Herdiana, H., & Jayatni, I. (2023). Hubungan Personal Hygiene, Aktivitas Fisik Dan Tingkat Stres Terhadap Kejadian Keputihan Pada Remaja Putri Kelas XII Di SMA Darussalam Kabupaten Garut Tahun 2023. SENTRI: Jurnal Riset Ilmiah, 2(10), 4318–4331. https://doi.org/10.55681/sentri.v2i10.1671
- Hillard, P. J. A. (2013). Practical pediatric and adolescent gynecology. Wiley Online Library.
- Ihsanpuro, F. N. A. (2025). The relationship of personal hygiene to the incidence of vaginal discharge in adolescents: A literature review. https://doi.org/10.30574/wjarr.2025.25.1.0026
- Kas, S. R. (2023). Determinan Tingkat Stres Remaja Putri Dengan Keluhan Keputihan. Jurnal Ilmiah Kesehatan Media Husada, 12(2 SE-Articles). https://doi.org/10.33475/jikmh.v12i2.327
- Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual hygiene, management, and waste disposal: practices and challenges faced by girls/women of developing countries. Journal of Environmental and Public Health, 2018(1), 1730964. https://doi.org/10.1155/2018/1730964
- Koto, V. F. (2018). Analisis Faktor Yang Memengaruhi Kejadian Keputihan (Fluor Albus) Pada Wanita Usia Subur Di UPT Puskesmas Lalang Medan Tahun 2017. Institut Kesehatan Helvetia.
- Lahme, A. M., Stern, R., & Cooper, D. (2018). Factors impacting on menstrual hygiene and their implications for health promotion. Global Health Promotion, 25(1), 54–62. https://doi.org/10.1177/1757975916648301
- Lemly, D., & Gupta, N. (2020). Sexually transmitted infections part 2: discharge syndromes and pelvic inflammatory disease. Pediatrics in Review, 41(10), 522–537. https://doi.org/10.1542/pir.2019-0078
- Liang, M., Simelane, S., Fortuny Fillo, G., Chalasani, S., Weny, K., Salazar Canelos, P., Jenkins, L., Moller, A.-B., Chandra-Mouli, V., Say, L., Michielsen, K., Engel, D. M. C., & Snow, R. (2019). The State of Adolescent Sexual and Reproductive Health. Journal of Adolescent Health, 65(6, Supplement), S3–S15. https://doi.org/https://doi.org/10.1016/j.jadohealth.2019.09.015
- Lowdermilk, D. L., Cashion, K., Perry, S. E., Alden, K. R., & Olshansky, E. (2019). Maternity and Women’s Health Care E-Book. Elsevier Health Sciences.
- Majeed, J., Sharma, P., Ajmera, P., & Dalal, K. (2022). Menstrual hygiene practices and associated factors among Indian adolescent girls: a meta-analysis. Reproductive Health, 19(1), 148. https://doi.org/10.1186/s12978-022-01453-3
- Miller, E. A., Beasley, D. E., Dunn, R. R., & Archie, E. A. (2016). Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique? Frontiers in Microbiology, 7, 1936. https://doi.org/10.3389/fmicb.2016.01936
- Mohammed, S., & Larsen-Reindorf, R. E. (2020). Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. Plos One, 15(10), e0241106. https://doi.org/10.1371/journal.pone.0241106
- Mulu, W., Yimer, M., Zenebe, Y., & Abera, B. (2015). Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot referral Hospital, Ethiopia: a cross-sectional study. BMC Women’s Health, 15(1), 42. https://doi.org/10.1186/s12905-015-0197-y
- Perdomo Sandoval, L. A., Villamil Camacho, D. F., & Goberna-Tricas, J. (2024). Self-Care Practices and Associated Sexual Health Risks Among Cisgender Women Sex Workers in Colombia. Sexuality Research and Social Policy, 21(2), 543–558. https://doi.org/10.1007/s13178-024-00935-2
- Rice, A., ElWerdany, M., Hadoura, E., & Mahmood, T. (2016). Vaginal discharge. Obstetrics, Gynaecology & Reproductive Medicine, 26(11), 317–323. https://doi.org/https://doi.org/10.1016/j.ogrm.2016.08.002
- Senderowitz, J. (1999). Making reproductive health services youth friendly. FOCUS on young adults.
- Seyfarth, F., & Elsner, P. (2010). Irritant Contact Dermatitis BT - Textbook of Aging Skin (M. A. Farage, K. W. Miller, & H. I. Maibach (eds.); pp. 825–832). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-540-89656-2_79
- Sihite, P. J., Nugroho, D., & Dharmawan, Y. (2017). Pengaruh Edukasi Kesehatan Reproduksi Terhadap Pengetahuan Siswa Tentang Triad KRR (SEKSUALITAS, HIV/AIDS, DAN NAPZA) DI SMK SWADAYA KOTA SEMARANG TRI WULAN II TAHUN 2017,. Jurnal Kesehatan Masyarakat; Vol 5, No 4 (2017): JULIDO - 10.14710/Jkm.V5i4.18355. https://ejournal3.undip.ac.id/index.php/jkm/article/view/18355
- Simpson, T., Merchant, J., Grimley, D. M., & Kim Oh, M. (2004). Vaginal douching among adolescent and young women: more challenges than progress. Journal of Pediatric and Adolescent Gynecology, 17(4), 249–255. https://doi.org/https://doi.org/10.1016/j.jpag.2004.05.008
- Sobel, J. D. (2016). Recurrent vulvovaginal candidiasis. American Journal of Obstetrics and Gynecology, 214(1), 15–21. https://doi.org/https://doi.org/10.1016/j.ajog.2015.06.067
- Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015). Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue. American Journal of Public Health, 105(7), 1302–1311. https://doi.org/10.2105/AJPH.2014.302525
- Srivastav, S., Singh, A., Shukla, P., & Maurya, S. P. (2024). Understanding Menstrual Hygiene Practices and Knowledge among Adolescent Girls: A Review. Journal of Advances in Biology & Biotechnology, 27(7 SE-Review Article), 1113–1117. https://doi.org/10.9734/jabb/2024/v27i71070
- Starrs, A. M., Ezeh, A. C., Barker, G., Basu, A., Bertrand, J. T., Blum, R., Coll-Seck, A. M., Grover, A., Laski, L., & Temmerman, M. (2018). Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. The Lancet, 391(10140), 2642.
- Torondel, B., Sinha, S., Mohanty, J. R., Swain, T., Sahoo, P., Panda, B., Nayak, A., Bara, M., Bilung, B., Cumming, O., Panigrahi, P., & Das, P. (2018). Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India. BMC Infectious Diseases, 18(1), 473. https://doi.org/10.1186/s12879-018-3384-2
- Umami, A., Paulik, E., Molnár, R., & Murti, B. (2022). The relationship between genital hygiene behaviors and genital infections among women : A systematic review. 17(1), 89–101. https://doi.org/10.20473/jn.v16i1.34402
- Venkatraman Chandra-Mouli, V. C.-M., & Patel, S. V. (2017). Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low-and middle-income countries. https://doi.org/10.1186/s12978-017-0293-6
- Werner, M. D., Punzi, M. C., & Turkenburg, A. J. K. (2024). Period Power: Organizational Stigma, Multimodality, and Social Entrepreneurship in the Menstrual Products Industry. Journal of Management Studies, 61(5), 2137–2180. https://doi.org/10.1111/joms.12974
- Xiao, Y., Ma, T., Wu, H., Su, Q., Zhou, Y., Zhou, B., Yang, K., Pu, Z., Feng, W., & Yong, X. (2024). Research progress of hydrogels in the prevention of pelvic inflammatory disease. MedComm–Biomaterials and Applications, 3(4), e100. https://doi.org/10.1002/mba2.100
References
Adolfsson, A., Hagander, A., Mahjoubipour, F., & Larsson, P.-G. (2017). How vaginal infections impact women’s everyday life: women’s lived experiences of bacterial Vaginosis and recurrent vulvovaginal candidiasis. Advances in Sexual Medicine, 7(1), 1–19. https://doi.org/10.4236/asm.2017.71001
Akanzum, J., & Pienaah, C. K. A. (2023). Review of the effects of adequate sanitary facilities on the participation and performance of the school girl child in Ghana. ISABB Journal of Health and Environmental Sciences, 8(1), 1–14. https://doi.org/10.5897/ISAAB-JHE2021.0073
Amabebe, E., & Anumba, D. O. C. (2018). Psychosocial stress, cortisol levels, and maintenance of vaginal health. Frontiers in Endocrinology, 9, 568. https://doi.org/10.3389/fendo.2018.00568
Anjarsari, N., & Sari, E. P. (2020). Relationship Stress Levels with Menstrual Cycle in Adolescent Girls. Psychiatry Nursing Journal (Jurnal Keperawatan Jiwa), 2(1 SE-Articles), 1–4. https://doi.org/10.20473/pnj.v2i1.19135
Baka, S., Demeridou, S., Kaparos, G., Tsoutsouras, K., Touloumakos, S., Dagre, M., Meretaki, S., Chasiakou, A., Koumaki, V., & Tsakris, A. (2022). Microbiological findings in prepubertal and pubertal girls with vulvovaginitis. European Journal of Pediatrics, 181(12), 4149–4155. https://doi.org/10.1007/s00431-022-04631-4
Bin, Z., Zhi, T., Laahirie, E., G., S. M., & A., B. G. (2022). Roles of the Microbiota of the Female Reproductive Tract in Gynecological and Reproductive Health. Microbiology and Molecular Biology Reviews, 86(4), e00181-21. https://doi.org/10.1128/mmbr.00181-21
Chen, Y., Bruning, E., Rubino, J., & Eder, S. E. (2017). Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Women’s Health, 13(3), 58–67.
Cohn, S., & Blumberg, R. L. (2020). Poverty, Water, Sanitation Insecurities, and the Challenges of Maintaining Menstrual Hygiene. In Gender and Development: The Economic Basis of Women’s Power (pp. 119–144). SAGE Publications, Inc. https://doi.org/10.4135/9781544381190.n9
Collins, M. K., McCutcheon, C. R., & Petroff, M. G. (2022). Impact of estrogen and progesterone on immune cells and host–pathogen interactions in the lower female reproductive tract. The Journal of Immunology, 209(8), 1437–1449. https://doi.org/10.4049/jimmunol.2200454
Darma, M., Yusran, S., & Fachlevy, A. F. (2017). Hubungan Pengetahuan, Vulva Hygiene, Stres, dan Pola Makan dengan Kejadian Infeksi Flour Albus (Keputihan) pada Remaja Siswi SMA Negeri 6 Kendari 2017. Jurnal Ilmiah Mahasiswa Kesehatan Masyarakat Unsyiah, 2(6).
Dorjey, Y., Wangmo, D., & Tshomo, D. (2022). Assessment of excessive vaginal discharge among women who presented to Phuentsholing General Hospital: A hospital‐based study. Health Science Reports, 5(5), e793. https://doi.org/10.1002/hsr2.793
Eduwan, J. (2022). Gambaran Pengetahuan Tentang Keputihan Pada Remaja Putri. Jurnal Vokasi Keperawatan (JVK), 5(1), 71–77. https://doi.org/10.33369/jvk.v5i1.22449
Girigoswami, K., Girigoswami, A., Harini, A., & Thanujashree, J. (2024). Knowledge on female hygiene and its associated diseases: a mini review. Arab Gulf Journal of Scientific Research, 42(3), 1117–1129. https://doi.org/10.1108/AGJSR-02-2023-0074
Hanifah, H., Herdiana, H., & Jayatni, I. (2023). Hubungan Personal Hygiene, Aktivitas Fisik Dan Tingkat Stres Terhadap Kejadian Keputihan Pada Remaja Putri Kelas XII Di SMA Darussalam Kabupaten Garut Tahun 2023. SENTRI: Jurnal Riset Ilmiah, 2(10), 4318–4331. https://doi.org/10.55681/sentri.v2i10.1671
Hillard, P. J. A. (2013). Practical pediatric and adolescent gynecology. Wiley Online Library.
Ihsanpuro, F. N. A. (2025). The relationship of personal hygiene to the incidence of vaginal discharge in adolescents: A literature review. https://doi.org/10.30574/wjarr.2025.25.1.0026
Kas, S. R. (2023). Determinan Tingkat Stres Remaja Putri Dengan Keluhan Keputihan. Jurnal Ilmiah Kesehatan Media Husada, 12(2 SE-Articles). https://doi.org/10.33475/jikmh.v12i2.327
Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual hygiene, management, and waste disposal: practices and challenges faced by girls/women of developing countries. Journal of Environmental and Public Health, 2018(1), 1730964. https://doi.org/10.1155/2018/1730964
Koto, V. F. (2018). Analisis Faktor Yang Memengaruhi Kejadian Keputihan (Fluor Albus) Pada Wanita Usia Subur Di UPT Puskesmas Lalang Medan Tahun 2017. Institut Kesehatan Helvetia.
Lahme, A. M., Stern, R., & Cooper, D. (2018). Factors impacting on menstrual hygiene and their implications for health promotion. Global Health Promotion, 25(1), 54–62. https://doi.org/10.1177/1757975916648301
Lemly, D., & Gupta, N. (2020). Sexually transmitted infections part 2: discharge syndromes and pelvic inflammatory disease. Pediatrics in Review, 41(10), 522–537. https://doi.org/10.1542/pir.2019-0078
Liang, M., Simelane, S., Fortuny Fillo, G., Chalasani, S., Weny, K., Salazar Canelos, P., Jenkins, L., Moller, A.-B., Chandra-Mouli, V., Say, L., Michielsen, K., Engel, D. M. C., & Snow, R. (2019). The State of Adolescent Sexual and Reproductive Health. Journal of Adolescent Health, 65(6, Supplement), S3–S15. https://doi.org/https://doi.org/10.1016/j.jadohealth.2019.09.015
Lowdermilk, D. L., Cashion, K., Perry, S. E., Alden, K. R., & Olshansky, E. (2019). Maternity and Women’s Health Care E-Book. Elsevier Health Sciences.
Majeed, J., Sharma, P., Ajmera, P., & Dalal, K. (2022). Menstrual hygiene practices and associated factors among Indian adolescent girls: a meta-analysis. Reproductive Health, 19(1), 148. https://doi.org/10.1186/s12978-022-01453-3
Miller, E. A., Beasley, D. E., Dunn, R. R., & Archie, E. A. (2016). Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique? Frontiers in Microbiology, 7, 1936. https://doi.org/10.3389/fmicb.2016.01936
Mohammed, S., & Larsen-Reindorf, R. E. (2020). Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. Plos One, 15(10), e0241106. https://doi.org/10.1371/journal.pone.0241106
Mulu, W., Yimer, M., Zenebe, Y., & Abera, B. (2015). Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot referral Hospital, Ethiopia: a cross-sectional study. BMC Women’s Health, 15(1), 42. https://doi.org/10.1186/s12905-015-0197-y
Perdomo Sandoval, L. A., Villamil Camacho, D. F., & Goberna-Tricas, J. (2024). Self-Care Practices and Associated Sexual Health Risks Among Cisgender Women Sex Workers in Colombia. Sexuality Research and Social Policy, 21(2), 543–558. https://doi.org/10.1007/s13178-024-00935-2
Rice, A., ElWerdany, M., Hadoura, E., & Mahmood, T. (2016). Vaginal discharge. Obstetrics, Gynaecology & Reproductive Medicine, 26(11), 317–323. https://doi.org/https://doi.org/10.1016/j.ogrm.2016.08.002
Senderowitz, J. (1999). Making reproductive health services youth friendly. FOCUS on young adults.
Seyfarth, F., & Elsner, P. (2010). Irritant Contact Dermatitis BT - Textbook of Aging Skin (M. A. Farage, K. W. Miller, & H. I. Maibach (eds.); pp. 825–832). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-540-89656-2_79
Sihite, P. J., Nugroho, D., & Dharmawan, Y. (2017). Pengaruh Edukasi Kesehatan Reproduksi Terhadap Pengetahuan Siswa Tentang Triad KRR (SEKSUALITAS, HIV/AIDS, DAN NAPZA) DI SMK SWADAYA KOTA SEMARANG TRI WULAN II TAHUN 2017,. Jurnal Kesehatan Masyarakat; Vol 5, No 4 (2017): JULIDO - 10.14710/Jkm.V5i4.18355. https://ejournal3.undip.ac.id/index.php/jkm/article/view/18355
Simpson, T., Merchant, J., Grimley, D. M., & Kim Oh, M. (2004). Vaginal douching among adolescent and young women: more challenges than progress. Journal of Pediatric and Adolescent Gynecology, 17(4), 249–255. https://doi.org/https://doi.org/10.1016/j.jpag.2004.05.008
Sobel, J. D. (2016). Recurrent vulvovaginal candidiasis. American Journal of Obstetrics and Gynecology, 214(1), 15–21. https://doi.org/https://doi.org/10.1016/j.ajog.2015.06.067
Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015). Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue. American Journal of Public Health, 105(7), 1302–1311. https://doi.org/10.2105/AJPH.2014.302525
Srivastav, S., Singh, A., Shukla, P., & Maurya, S. P. (2024). Understanding Menstrual Hygiene Practices and Knowledge among Adolescent Girls: A Review. Journal of Advances in Biology & Biotechnology, 27(7 SE-Review Article), 1113–1117. https://doi.org/10.9734/jabb/2024/v27i71070
Starrs, A. M., Ezeh, A. C., Barker, G., Basu, A., Bertrand, J. T., Blum, R., Coll-Seck, A. M., Grover, A., Laski, L., & Temmerman, M. (2018). Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. The Lancet, 391(10140), 2642.
Torondel, B., Sinha, S., Mohanty, J. R., Swain, T., Sahoo, P., Panda, B., Nayak, A., Bara, M., Bilung, B., Cumming, O., Panigrahi, P., & Das, P. (2018). Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India. BMC Infectious Diseases, 18(1), 473. https://doi.org/10.1186/s12879-018-3384-2
Umami, A., Paulik, E., Molnár, R., & Murti, B. (2022). The relationship between genital hygiene behaviors and genital infections among women : A systematic review. 17(1), 89–101. https://doi.org/10.20473/jn.v16i1.34402
Venkatraman Chandra-Mouli, V. C.-M., & Patel, S. V. (2017). Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low-and middle-income countries. https://doi.org/10.1186/s12978-017-0293-6
Werner, M. D., Punzi, M. C., & Turkenburg, A. J. K. (2024). Period Power: Organizational Stigma, Multimodality, and Social Entrepreneurship in the Menstrual Products Industry. Journal of Management Studies, 61(5), 2137–2180. https://doi.org/10.1111/joms.12974
Xiao, Y., Ma, T., Wu, H., Su, Q., Zhou, Y., Zhou, B., Yang, K., Pu, Z., Feng, W., & Yong, X. (2024). Research progress of hydrogels in the prevention of pelvic inflammatory disease. MedComm–Biomaterials and Applications, 3(4), e100. https://doi.org/10.1002/mba2.100