A medical imaging and therapy device is provided that may include any of a number of features. One feature of the device is that it can acoustically couple an ultrasound therapy transducer to a patient. In some embodiments, the medical imaging and therapy device is configured to conform to the anatomy of a patient's perineal area to acoustically couple an ultrasound therapy transducer to the patient for treatment of BPH. The medical imaging and therapy device can be used in therapeutic applications such as Histotripsy, Lithotripsy, and HIFU, for example. Methods associated with use of the medical imaging and therapy device are also covered.