A visit to the health-care provider isn't at the top of every woman's list of good times. Especially when it comes to the pelvic exam (which includes a look at your vaginal interior), most women dread the experience.

But a physical exam is one of the necessary steps for maintaining good health.

A woman should have a yearly physical exam, including a Pap smear if she is 18 or older, or at any age if she is sexually active.

It's important to choose a health-care provider who makes you feel comfortable, doesn't hurry during the exam, is sympathetic to your doubts and fears, listens carefully to and answers all your questions, and never discourages you from asking any kind of question.

Annual Health Checkups
An annual physical checkup is an excellent way to detect most health problems early rather than late. Your health-care provider will perform tests appropriate to your age.

During each visit, your weight and blood pressure will be recorded. If you are over 40, a urine sample will be examined.

This is also a good opportunity for your health-care provider to review your medical history and that of your family. Knowing your family's health status helps your health-care provider diagnose, prevent and treat diseases.

Routine tests performed during this visit can uncover problems even before there are symptoms. For example, patients with high blood pressure do not show any symptoms until they have a heart attack, a stroke or kidney failure.

Many times, the potentially dangerous disease diabetes is suspected when a urine test shows a trace of sugar. A fasting blood-sugar test (no food after midnight of the night before the test until your blood is drawn the next day) will confirm the diagnosis.

Diabetes is the term for breakdown of the body's sugar-control mechanism, either because not enough insulin is produced or because the body is insensitive to insulin.

High cholesterol can be detected in a routine blood test. The health-care provider can then recommend modifications in diet.

If you're a young woman, your first pelvic exam is very important. The experience may shape how you will behave in future exams and even whether you'll consult a health-care provider in the future.

Sometimes personal discomfort or cultural preference can make the experience a disaster. Some women wish to remain absolutely "virginal" until their wedding night, allowing only a limited pelvic exam until that time, and even this may be unpleasant for them or impossible for the health-care provider to perform.

Are you a teenager who's not sexually active? (Good for you!) It may be a good idea for you to find a regular health-care provider.

By developing a comfortable relationship with the health-care provider, you will discover that everything you may discuss will be confidential -- sexuality, contraception and sexually transmitted disease, among other topics.

The Questionnaire and Preliminaries
Before the examination itself, you'll be given a health questionnaire to fill out, which will furnish your health-care provider with your own medical history and that of your family.

Knowing your collective family health history allows your health-care provider to most effectively diagnose, prevent, treat and cure the health problems you may develop.

A record of your previous surgeries and obstetrical and gynecological history are also very important. You will be asked:

• Your age at your first menstrual period
• The number of days in your cycle (from the first day of bleeding to the first day of the next cycle)
• How many days the bleeding continues
• The date of your last period
• Whether you experience cramps or heavy bleeding

The questionnaire also asks the date of your last Pap smear and details of your pregnancies, contraception, STD's, sexual functioning, sexual behavior, mammograms, immunizations and medications.

Other helpful information includes whether you have allergies; your experience with tobacco, alcohol and drugs; background on any hospitalization and weight gain or weight loss; as well as your dietary and nutritional awareness, and fitness and psychological status.

When you've completed the questionnaire, you will be weighed, and your blood pressure, respiration and pulse will be checked. You may also be handed a paper cup so you can provide a urine sample.

You're fully clothed during the first encounter with the health-care provider, so you're more comfortable as the two of your review the questionnaire and discuss any questions you may have.

If this will be your first pelvic exam, now is the time to say so.

Next, you'll be asked to go to the examining room to get undressed and put on a paper or cloth gown.

Preparing For the Pelvic Exam
Knowing what happens in a pelvic exam ahead of time can alleviate your fears and help you relax. First, there are a few things NOT to do in the 24 hours before the appointment:

Don't douche or insert any medication into the vagina, because either one can interfere with detecting a possible infection.

This is particularly important because a Pap smear (to test for cancer of the cervix) cannot be performed if there is any sign of infection or if there is vaginal bleeding.

In case of infection, the health-care provider will perform appropriate tests, provide treatment, and ask you to return in two or three weeks for a re-check. If the infection has cleared up, the Pap smear can be performed.

The Physical Exam
The physical exam includes checking your head and neck for any abnormalities. Your thyroid gland, located at the base of your throat, is examined by touch (palpated). Attention is paid to your chest and heart for any abnormal sounds.

The health-care provider examines your breasts in much the same way you yourself do during a self-examination. (More on this in Step 6.) This is a good time for you to find out if your own self-examination technique is correct. The abdominal exam includes palpation of the liver and kidneys, also to observe any abnormal growth or sounds.

Breast exam by the health-care provider.

The Pelvic Exam
For the pelvic exam, you lie on your back with your feet in stirrups at each side of the examining table. This is to spread your legs apart so the health-care provider can more easily examine the genital area.

The examination itself can sometimes be uncomfortable, but it usually doesn't hurt.

A relaxed body is more easily examined, since tension causes contraction of the muscles around the vagina and rectum, making insertion of the speculum (the instrument that spreads the vagina) and finger difficult.

To release any tension, you may want to take some slow, deep breaths.

The vulva: A - clitoris, B - labium minus, C - urethral opening, D - vaginal opening, E - labium majus, F - anus.

The health-care provider first checks the vulva, the group of external female genitals, for any unusual lesion, venereal warts, herpes or cancer.

Next comes insertion of the plastic or metal speculum into the vagina, spreading it for inspection of the uterus opening and to take the Pap smear -- the collecting of sample cells from the cervical area.

The Pap Smear
About 40 years ago, before the introduction of the Pap smear, cervical cancer was the leading cause of cancer death in women.

A pathologist named George Papanicolaou discovered the relationship of cellular changes and cancer of the cervix.

Normally the cervical cells grow in an orderly fashion. Yet sometimes -- probably due to certain viruses, sexual intercourse at an early age and numbers of sexual partners -- there are changes in the cell size and configuration.

In the early stage, those changes are called dysplasia. The dysplastic cells, if left untreated, may develop into cervical cancer.

According to the College of American Pathologists, early detection by Pap smears followed by appropriate treatment has led to a 70% reduction in the incidence of the disease in the United States.

It is now a less frequent cause of women's deaths -- 4,800 in 1996 -- than cancers of the lungs, breast, colon, ovary and uterus.

Unfortunately, cervical cancer right now is the leading cause of cancer disease and death among women in developing countries.

There are an estimated 340,000 new cases and 160,000 deaths each year. Cervical cancer is particularly high in India, southeastern Asia, China, sub-Saharan Africa, Central America and tropical South America.

In Mexico, according to that country's National Institute of Statistics and Information, nearly 5,000 women die every year from the disease and 15,000 new cases are registered, more than half of them in advanced stages.

A Pap smear is taken by using a wooden spatula to scrape the cervix and a small brush for the cervical canal.

The collected cells are placed on a glass slide and sent to a lab to be examined under a microscope. If abnormal cells are found, the doctor is notified and begins appropriate treatment.

Pap smear: A - uterus, B - cervix, C - vagina, D - speculum.

Some abnormal cells are caused by inflammation. They can be treated and the Pap smear repeated in three to six months.

Dysplasia
If there is a possibility of dysplasia, your health-care provider will perform a colposcopy. During the colposcopic exam, a speculum is inserted into the vagina, followed by a colposcope -- a vaginal microscope that focuses an intense light, allowing exact location of the abnormal cervical area.

The health-care provider may take sample cells for examination. If necessary, cells can also be scraped from the cervical canal.

Treatment varies with the findings.

Concluding the Pelvic Exam
Following the speculum exam, the health-care provider places lubricant on a gloved hand and inserts two fingers into the vagina. Any abnormality of the vaginal wall, the bladder or the rectum can be noted.

Then, while touching the cervix with the fingers and pushing up, the health-care provider's other hand pushes down on the lower abdomen. This way the shape, consistency, size and position of the uterus are checked, as well as the ovaries and the Fallopian tubes.

The pelvic exam: A - uterus, B - cervix, C - vagina.

Especially in women over the age of 40 or those with a tipped uterus, the health-care provider confirms the previous findings by placing one finger in the rectum and another in the vagina.

If the woman is over 40, the health-care provider also tests the stool for signs of blood. The presence of blood could mean the possibility of colon cancer, the third most common cancer in women.

The extremities are also checked for any abnormal pulses and edema (abnormal bloating or accumulation of fluids).

The annual exam as described here is an essential step in disease prevention for women.