Near the end of the first year, only in about 50 percent of boys is the foreskin likely to retract behind the coronary sulcus; by age three it reaches about 89 percent. The rate of circumcision is 8% at six to seven years of age and 1% at 16 to 18 years of age.
Circumcision can be primary, physiological and without scarring, or secondary and pathological, such as occlusive dry glans. Phimosis should be distinguished from normal adhesion of the foreskin to the glans, which is a physiological phenomenon.
Foreskin impaction is an emergency: a too narrow foreskin opening that retreats into the coronal sulcus can lead to compression of the penile shaft and cause edema. This can lead to interference with perfusion distal to the constricted ring and result in continuous necrosis.
Treatment of circumcision depends on parental choice: 1. absolute indications for circumcision are secondary circumcision; 2. surgical indications for primary circumcision are recurrent priapism, and recurrent urinary tract infections with combined urinary tract abnormalities; 3. simple balloon-like foreskin during urination is not a strict indication for circumcision; 4. routine circumcision of newborns to prevent penile cancer is not an indication
5. contraindications to circumcision are coagulopathy, local acute infection, and congenital anomalies of the penis, especially hypospadias and buried penis, as the foreskin can be used for later reconstructive surgery.