Circumcision for phimosis and other medical indications in Western Australian boys

To the Editor: The study by Spilsbury and colleagues provides new data on rates of phimosis, balanoposthitis, and lichen sclerosus.1 However, it does cite sources — Øster2 and Shankar and Rickwood3 — that indicate very low rates of phimosis. Øster was a school medical officer who followed up his subjects for several years, making frequent penile inspections and giving them continual instruction on prepuce care. Without such extraordinary attention, it would be highly unlikely the general population would have such low rates of phimosis.