Keratinization of the adult male foreskin and implications for male circumcision

In their response to our study, Gray et al. question our conclusion that there is no significant difference between the keratin thickness of the inner and outer foreskin keratin layer [1,2]. However, their arguments are not supported by any quantitative published data or scientific references. Male circumcision has the potential to play an important role in HIV prevention and understanding its mechanism is critical. Great interest in this topic has unfortunately also led to a large amount of erroneous information. Dr Morris, one of the 'letter to the editor' authors, states on his circumcision website that the inner foreskin 'resembles other mucosal epithelia such as constitute the cervix, nasal passages and rectum' [3]. This statement is incorrect: the inner foreskin is composed of stratified squamous epithelium, not the simple columnar epithelium observed in the cervix and rectum [4--6]. This type of misinformation and assumption must be replaced by evidence and data such as what we have provided in our detailed analysis of the foreskin keratin layers.