There comes a time in every woman's life, when she needs to face "the stirrups." And no, there's no saddle or horse involved. At the magical age of 18 or whenever a woman plans to become sexually active (whichever occurs first), she should begin having annual check ups by a healthcare provider.

Since October is National Breast Cancer Awareness Month, it is especially important for all women to understand the importance of this exam. The annual exam consists of health education, a physical examination with a Pap smear to screen for cervical cancer and, when appropriate, screening tests for sexually transmitted infections.

So what happens during the clinic visit? It begins with a review by the clinician of your complete medical history. This information helps the clinician identify risk factors and issues that she or he can discuss with you during your visit.

As part of the physical exam, self-breast examination is taught. The breast self-exam is a valuable habit for women of all ages to develop. During 2001, an estimated 192,000 new cases of breast cancer are expected to occur among women in the United States.

Approximately one in eight women will develop breast cancer if they live long enough. This risk increases with age, with more than 77 percent of breast cancers occurring in women over age 50. Almost 5 percent of women who get breast cancer are in their mid-20s to late 30's.

Breast cancer is the most common cancer in women other than skin cancer. Your risk is doubled if an immediate family member (mother, sister or daughter) was diagnosed with breast cancer. Having two immediate family members with breast cancer increases your risk by five times. However, a simple monthly self-exam can assist in early detection and successful treatment.

Now for the infamous stirrup part. Though the pelvic exam may be an awkward experience, it should not be painful. You may feel pressure that can be uncomfortable but should not feel pain. You will be asked to lie down, slide to the end of the examination table and put your heels in the footrests, called stirrups.

The clinician then examines the cervix and does a Pap smear, which involves using a flat stick and a soft brush to remove cells from your cervix. Since the cervix has few nerve endings, you should not feel significant discomfort.

The Pap smear can detect abnormal cell changes before they develop into cancer. Therefore, an abnormal Pap smear rarely means cancer, but rather might indicate a need for more thorough evaluation and possible treatment to prevent cancerous cells from occurring.

Feeling tense, anxious or even embarrassed during the exam is natural. Deep breathing and relaxation techniques can be helpful. The good news is that the whole process takes mere minutes, while taking advantage of an annual exam can provide a lifetime of benefits.

The exam is also a great time to discuss any questions or concerns you may have regarding birth control, sexually transmitted infections, gynecological problems (such as ovarian cysts, vaginal infections, cramps, etc.) or other preventive health issues. Your clinician can also provide referrals for medical, nutritional and psychological conditions as needed.

So don't "stirrup" trouble by delaying your annual check up — make an appointment soon.