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What an excellent article by Metcalfe and Elyas!1 The authors were absolutely correct in noticing from their own urology practices that family doctors face a lot of uncertainty and patient concern about foreskin normality and abnormality. This paper did an excellent job of summarizing the common concerns about and management of foreskins, while detailing the uncommon but not-to-miss balanitis xerotica obliterans. The scenarios and pictures made the article very readable and interesting. I believe I have a much better understanding of how to counsel patients and how to spare urologists unnecessary referrals. Thanks!