The elasticity-based, locally exact homogenization theory for unidirectional composites with hexagonal and tetragonal symmetries and transversely isotropic phases is further extended to accommodate cylindrically orthotropic reinforcement. The theory employs Fourier series representations of the fiber and matrix displacement fields in cylindrical coordinate system that satisfy exactly equilibrium equations and continuity conditions in the interior of the unit cell. Satisfaction of periodicity conditions for the inseparable exterior problem is efficiently accomplished using previously introduced balanced variational principle which ensures rapid displacement solution convergence with relatively few harmonic terms. As demonstrated in this contribution, this also applies to cylindrically orthotropic reinforcement for which the eigenvalues depend on both the orthotropic elastic moduli and harmonic number. The solution's demonstrated stability facilitates rapid identification of cylindrical orthotropy's impact on homogenized moduli and local fields in wide ranges of fiber volume fraction and orthotropy ratios. The developed theory provides a unified approach that accounts for cylindrical orthotropy explicitly in both the homogenization process and local stress field calculations previously treated separately through a fiber replacement scheme. Comparison of the locally exact solution with classical solutions based on an idealized microstructural representation and fiber moduli replacement with equivalent transversely isotropic properties delineates their applicability and limitations.