Painful coitus is a distressing symptom for both sexes. Often, physician and patient avoid this issue because of their own inability to deal with such problems. Dyspareunia may be caused by a variety of conditions, mainly related to the reproductive system. However, even where medical or surgical treatment is contemplated, therapy will usually require some form of sex counselling. A sex-oriented history which resembles the usual medical format is used in the assessment. The PLISSIT model of therapy allows the practitioner to begin treatment, and to make a referral when his or her "comfort index" may be exceeded.