Potential Effects of Piper Crocatum and Piper Betle Leaf Formulations in Managing Abnormal Vaginal Discharge: A Systematic Review and Meta-Analysis

Abstract

Abnormal vaginal discharge is a common gynecological complaint and may be caused by vaginal microbiota imbalance, vaginal infection, irritants, hormonal changes, or other gynecological conditions. Betel leaf (Piper spp.) contains bioactive compounds with antimicrobial, anti-inflammatory, and astringent properties. This review evaluates the potential effects of Piper spp. formulations in managing abnormal vaginal discharge. PubMed, Cochrane/CENTRAL, ScienceDirect, and Google Scholar were searched for studies published from 2006 to 2026. Search terms included Piper crocatum, Piper betle, betel leaf, red betel leaf, green betel leaf, vaginal discharge, and abnormal vaginal discharge. Human clinical studies evaluating Piper spp. formulations for abnormal vaginal discharge were eligible. Etiology, formulation, method of application, outcome measurement, and symptom-score details were extracted. Random-effects meta-analysis was performed using Review Manager 5.4.1. Eight clinical studies were included in the qualitative synthesis, comprising 243 participants exposed to Piper spp. interventions. Six studies evaluated red betel leaf (Piper crocatum) and two evaluated green betel leaf (Piper betle). Most studies did not microbiologically confirm the etiology of abnormal vaginal discharge; therefore, the diagnostic basis was generally clinical or symptom-based. Common formulations were decoctions, most commonly applied as external genital/vaginal area washes, rinses, or flushes. Within-group pre-post meta-analysis showed a significant reduction in vaginal pH (SMD -1.82; 95% CI -2.21 to -1.44; p < 0.00001; I2 = 0%) and abnormal vaginal discharge symptom scores (SMD -3.25; 95% CI -4.77 to -1.74; p < 0.0001; I2 = 82%).To conclude, Piper spp. betel leaf formulations had an advantage in improving abnormal vaginal discharge.