To the Editor: The article by Spilsbury et al starts well by acknowledging at least some of the serious health consequences of not circumcising,1 but then digresses into a study of whether a particular medical reason for circumcision — namely phimosis early in life — has been overstated in medical records.

So what! Circumcision is a simple procedure that conveys significant lifetime health benefits. Like immunisation, any minor adverse effect can be treated immediately, and catastrophes are virtually nonexistent. An extensive literature review (263 references) of the numerous scientific studies points overwhelmingly to the net advantage of circumcision to male health and sexual function.2 Benefits include:

• An 11-fold reduction in risk of urinary tract infections, which are extremely painful and can even lead to death (from kidney failure, meningitis and bone marrow disease).2-4 Such infections present in about one in 20 uncircumcised boys.

• Virtually complete elimination of the risk of invasive penile carcinoma, which approximately one in 400–900 uncircumcised men will get during their lifetime (US and Swedish data). In parts of Africa and South America the rate is very much higher. A quarter of those affected will die from it while the rest will need at least partial penile amputation.2,5 (This should not be confused with the often quoted, but misleading, annual incidence figures of one in 100 000 for developed nations).

• Reduction in risk of cervical cancer by at least 5-fold in female partners of circumcised men, established in a large multinational study last year.6 Notably, these workers found that condom use by uncircumcised men did not reduce the risk.

• Elimination of phimosis, balanitis, posthitis, and paraphimosis, which affects up to 18% of uncircumcised boys by the age of 8 years.2

• No need to circumcise later in life, when cost and risk is higher.

• Reduction, possibly absolute,7 in risk of heterosexually acquired HIV infection8 — the keratin-poor inner lining of the foreskin being the portal for entry of this virus which then rapidly infects immune system cells in the epithelium.9

• Reduction in risk of sexual problems.2

• Improved appearance2 and sexual appeal.10

Given the enormous benefits to public health, circumcision needs to be strongly promoted.