The Effect of Social Media Use on Women's Symptom Relieving Practices for Genital Infection

Introduction

Reproductive health problems come into prominence throughout the climacterium, which includes the menopause phase, particu-larly during their adulthood when women gain their reproductive features [1-3]. Genital tract infections are among the reproductive health problems and one of the most common causes of gynae¬cology outpatient clinic applications [4]. Every year, nearly one million women worldwide suffer from genital tract infections and 75% of women have a history of genital infections [4]. The studies have reported that the prevalence of genital infection ranges be¬tween 27.6 and 74% [5-11].

Burning, pain, bleeding, malodorous vaginal discharge, dysuria, and dyspareunia are the most common symptoms of genital infec¬tions that affect women’s physiological and psychosocial health [1,2,4]. Women’s perceptions on abnormal vaginal discharge, which is a symptom of genital infection, differ. Therefore, some women apply to a health institution, whilst others do not seek treatment even if the volume of vaginal discharge is substantial. A study reported that 57% of women who were affected with gen¬ital infection requested medical treatment from a healthcare in¬stitution, 64% accepted such abnormal symptoms as normal, and 28% shared their genital infection problems with their families or friends [12].

Traditional practices for genital infection are extensively used among women, with or without medical treatment. These practic¬es include cleaning the genital area with some products, placing a herbal cure inside the vagina, wiping the vagina with yoghurt, propolis, honey, vinegar, soda, lemon juice, boric acid, and drink¬ing juice of various plants after boiling them such as onion, pars¬ley, corn silk, horsetail, yarrow, chamomile, linden, tea tree, zuc-chini, and fig, performing hot application, taking a milk bath, and applying apple cider vinegar [13-18].

Social media has an important place among women to share their experiences. Since many women are ashamed and afraid about many health-related issues, particularly gynaecological diseases, they perceive social media as a confidante during information col¬lection process [19,20]. Social media leads people to learn about alternative medical practices and take various actions for the treat¬ment of their diseases [21]. The studies have reported that women who have any disease and follow the publications containing herb¬al products in the media have a higher tendency to use herbal prod¬ucts [22,23]. For this purpose, answers to the following research questions were sought:

1. What are the symptom-relieving practices of women who have been diagnosed with genital infections?

2. Does the use of related social media by women who have been diagnosed with genital infection affect their symptom-reliev-ing behaviours?

Method

The study was conducted as descriptive and correlational. The population of the study consisted of 2000 women who applied to Gynaecology Outpatient Clinic of Erciyes University Health Ap-plication and Research Centre and were diagnosed with a geni¬tal infection between January and December 2018 (the archive of the Erciyes University Health Application and Research Centre, 2018). The sample consisted of women who applied to Gynaecol¬ogy Outpatient clinic of Erciyes University Health Application and Research Centre between September and December 2019 due to genital infection. The sample size was calculated in the G-Power software as n=315 with the effect size of 0.2, the confidence inter¬val of 95%, and the type 1 error of 0.05 [9,24]. The study included 315 women aged 19 and above who were literate, able to commu¬nicate well, diagnosed with genital infection (vaginitis, cervicitis, etc.), sexually active, and were voluntary to participate. Migrant women were excluded from the study.

Following the outpatient clinic examination, the researcher ex-plained the objective of the study to women who were diagnosed with genital infection and those who agreed to participate signed an informed consent form. She then collected data by using the “Introductory Information Form” as well as the “Genital Hygiene Behaviour Inventory” to assess genital hygiene behaviours, and the “Information Form on Genital Infection/Symptom Relieving Practices and Use of Social Media” to determine the health-seek-ing behaviours of women with genital infections on social me¬dia. The researcher filled the questionnaire and scales by using the face-to-face interview method. A preliminary application was made to 15 women, who constituted 5% of the sample (n=315), in order to test the operability of the questionnaires. Following the preliminary application, necessary revisions were made and the questionnaires were finalized. Women who were included in the preliminary application were excluded from the study. For the study, an Academic Committee Decision, Ethics Committee Deci¬sion, and written Institutional Permission were obtained.

The IBM SPSS (Statistics Package for Social Sciences) v.22 sta¬tistical software was used to analyse the data. As descriptive statis¬tics for the data, percentage, arithmetic mean, standard deviation, median, minimum and maximum values were provided. The Sha¬piro-Wilk normality test and Q-Q graphs were used to determine whether or not the data were normally distributed. The Indepen¬dent Samples t-test, ANOVA, and Bonferroni test were also em¬ployed. The statistical significance level was accepted as p<0.05.

Results

The mean age of the women who participated in the study was found to be 36.08±10.35.

Table 1 shows the characteristics of the participants concerning women’s health. It was found that 35.0% of the women com¬plained of itching, 85.0% were diagnosed with vaginitis, and 65.7 % received antifungal treatment. The women with genital infec¬tions got 79.51±9.59 scores on the GHBI. 86.3% of the women had itching, 48.3% redness, 87.0% burning, 65.4% malodorous vaginal discharge, 55.9% dysuria, 55.6% abdominal pain, 52.1% dyspareunia, and 19.7% vaginal bleeding problems.

                                         Table 1: Characteristics Regarding Women’s Health

Table 2 shows the GHBI scores of women based on some charac¬teristics. It was determined that the women, who had previously been diagnosed with a genital infection, did not get information on genital infection, and did not use social media, had lower GHBI mean scores, and the difference between the groups was statisti- cally significant (p=0.013, p≤0.001, p≤0.001, respectively). The variables of the number of genital infections per year, traditional practice for genital infection, and the status of paying attention to the recommendations in the social media had no effect on the GHBI scores (p>0.05).

      Table 2: Genital Hygiene Behaviour Inventory (GHBI) Scores of the Women based on Some of Their Characteristics

Table 3 shows the social media use characteristics of the women. It was determined that 64.8% of the women used social media, 54.4% used social media to get information, 56.4% believed that information on social media was partially accurate-reliable, 50.5% disregarded the recommendations on social media, and 65.2% thought that the recommendations shared on social media were not more effective than medical treatment.

            Table 3: Social Media Use Characteristics of the Women

Table 4 includes the genital infection experiences of the women and their status of getting information. It was determined that 66.3% of the women’s first response to women’s gynaecological problems was to consult a physician, 77.8% had previously been diagnosed with genital infection, 42.1% of the women who had previously been diagnosed with genital infections had a period between two and twelve months between their last two genital in¬fection diagnoses, 76.8% of the women had genital infections 1-3 times a year, 56.2% got information about the genital infection, and 43.0% of women got information on genital infection from health personnel, and 54.6 % performed traditional practices for genital infection.

Table 5 shows the practices related to the problems experienced by women due to genital infection. It was found that 31.7% of women douched their vaginas with soap and water, 38.0% of these women learned that information through social media, and 39.0% of the women who douched their vaginas with soap and water thought that this procedure had a positive effect on the treating genital in-fection, and all of the women (n=12) who douched their vaginas with soap and water shared that with their family, relatives, and neighbours.

It was determined that 15.9% of women used grape/apple cider vinegar for genital infection, and 56.0% of those who used grape/ apple cider vinegar learned that information through social media, 74.0% of women who used grape/apple cider vinegar thought that this procedure had a positive effect on treatment of genital infec¬tion, and all of the women (n=8) who used grape/apple cider vine¬gar shared that with their family, relatives, friends, and neighbours.

It was determined that 27.6% of th women drank herbal juice (parsley, onion, thyme, rosemary, sage, nettle) for genital infec¬tion and 60.9% of those who drank herbal juice learned that in¬formation through social media, 55.2% of the women who drank herbal juice thought that this procedure had a positive effect on the treating genital infection, and 95.7% (n=23) of them who drank herbal juice shared that with their family, relatives, friends, and neighbours.

                     Table 5: The Practices for the Problems Experienced By the Women Due To Genital Infection.

Additionally, it was determined that other practices associated with genital infection include douching with hot water (66.7 %) and using carbonated water (22.2 %) and cologne (11.1%).

Discussion

Women experienced mostly problems of itching, redness, burning, malodorous vaginal discharge, dysuria, abdominal pain, dyspareu¬nia, and vaginal bleeding in this study (Table 1). The studies have reported that there are complaints such as excessive amounts of malodorous and cheesy vaginal discharge, itching, abdominal pain unrelated to menstruation, genital ulcers, malodorous vaginal dis¬charge, frequent urination, dysuria, lower abdominal and inguinal pain, hyperaemia in the cervix, cervical erosion, dyspareunia, and postcoital bleeding and intermittent bleeding [9,12,25-27]. It can be thought that all of these symptoms have a physical, social, and psychological impact on women, leading to the development of various health-seeking behaviours.

In this study, more than half of the women used social media to get information, they believed that information shared on social media is partially accurate-reliable, and nearly half believed that recom¬mendation shared on social media is ineffective for medical treat¬ment (Table 3). The studies reported that women were willing to try social media posts and compared the shared information with their own experiences [28]. In a study, the web page contents were examined and then it was determined that treatment approaches such as CAM related to women’s health were included, and they included treatment recommendations or guidance regarding gy¬naecological diseases [29]. On the pages where alternative treat¬ments are shared, recommendations for relieving the symptoms of genital infections include the use of yoghurt, probiotics, garlic, tea tree oil, and boric acid [30]. It was found that the internet pages with the most shared herbal products contained information about the benefits of plants, but more than half of the shares did not in¬clude a source or expert opinion, and misleading content received more interaction [31-33].

It was determined in this study that more than half of the women used traditional methods for genital infection (Table 4). The stud¬ies reported that women with gynaecological problems performed traditional methods and used herbal products [27,34,35].

The study determined that the majority of the women were influ¬enced by the social media posts about genital infection and they tried the practices they learned in these posts on their own bodies (Table 5). In a study, it was found that 3% of participants were harmed by health information obtained on the Internet [36]. Like¬wise, 43.9% of the women who applied intravaginal herbs com¬plained of dyspareunia, 46.2% dysuria, 40.8% a change in vaginal discharge, and 46.1% abdominal pain [37]. These results indicated that the women were highly influenced by social media and they took the recommendations on women’s health into consideration.

In this study, it was found that almost one third (31.7%) of the wom¬en douched their vaginas with soap and water for genital infection, and 38.0% of those who douched their vaginas with soap and wa¬ter learned that information through social media, and 39.0% of women who douched their vaginas with soap and water thought that this procedure had a positive effect on the treating genital in¬fection (Table 5). It was stated that around half of African-Amer-ican women and nearly half of American women douched their vaginas and vaginal douching increased the risk of genital infec¬tion 2.5 times [38,39]. The studies conducted in Turkey reported that 66.7% of women with VVC douched their vaginas with soap and water, 51.5% with water and antiseptic, and 75.8% only with water [40,41]. The studies on VVC infection reported that wom¬en used water and commercial solutions that contain vinegar as a source of vaginal douching [18,42]. It was determined that nat¬ural products were preferred for vaginal douching, according to the findings of this study (Table 5). This could be thought to be attributed to easy access to natural products, their low cost, and the fact that the products most frequently recommended by other women were also natural. The tendency to use herbs in women’s health has increased all across the world due to the reasons such as the difficulty of modern medical treatment, high cost, and in¬effective treatment [12,13,25]. In the literature, women generally believe that it is worthwhile to try herbal treatments in addition to modern medicine, are unworried about possible side effects, and regard herbs as reliable products that have been used since ancient times [40,43].

When the literature is examined, it is stated that the sources where vaginal douching is learned are mostly family, friends, neighbours and social media [8,41,44], and women who benefit from the prac¬tices they do recommend them to family members and friends via social media [45-48]. This study was found that almost a quarter of women drank herbal juice (parsley, onion, thyme, rosemary, sage, nettle) for genital infection, and they learned that informa¬tion mostly through social media, more than half of the women who drank herbal juice thought that this procedure had a positive effect on the treating genital infection, and 95.7% of them shared that with their family, relatives, friends, and neighbours (Table 5). In a study, 4.3% of women with vaginal discharge did prac¬tices, such as drinking nettle-parsley juice, placing boiled garlic in the vagina, applying apple oil and sugar in the vagina. 58.8% of women learned about these practices from family and relatives, 14.7% from television, 1.7% from books, magazines, and news¬papers, and 20.6% from healthcare professionals. While 44.1% of the women thought that the non-medical treatment method treated, 67.6% stated that they benefited from the method they used [34].

Conclusion

In this study, which examined the effect of social media on symp¬tom relief practices of women with genital infections, it was found that 77.8% of the women had previously been diagnosed with the genital infection and 76.8% had genital infections 1-3 times a year, and 54.6% did traditional practice for genital infection and the most common traditional practices were douching the cavity with soap and water, drinking herbal juice, and douching the cavity with grape/apple cider vinegar. The women who had previously been diagnosed with genital infection but did not receive information about it had lower GHBI mean scores. Additionally, 29.7% of the women obtained information about genital infection through so¬cial media and women who did not use social media had a lower GHBI mean score.

Recommendations

In the light of the data of this study, healthcare professionals should pay more importance to genital infection and coping practices in primary health care services, and online education brochures de¬scribing how to protect against genital infections by collecting de¬tailed data, considering the cultural structure of the society, should be shared on social media. Healthcare professionals should create reliable websites where women with genital infections can seek counselling, and women should be provided with accurate and reliable information through social media channels. Additionally, health professionals should educate students on correct genital hy¬giene behaviours and proper use of social media within formal ed¬ucation at schools and studies with a high level of evidence should be conducted on the subject.

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