[desmondquek]

His email explained how the foreskin of his penis had been surgically removed two years before.

This is commonly known as circumcision, but Alex had come to believe it should be regarded as "male genital mutilation".

"I had issues with a tight foreskin," he eventually wrote in his final email,
"but from my late teens it created issues in the bedroom as it meant my foreskin would not retract over the glans as intended which caused some awkward moments."

The medical name for Alex's problem is phimosis.
It simply means his foreskin was too tight to pull back from the head of his penis, or the "glans" as Alex referred to it in his email.

In England, the NHS advises topical steroids and stretching techniques -
and circumcision as a last resort.

Over in Canada, where circumcision is more common, Alex was referred to a urologist.

"He immediately suggested circumcision," Alex wrote.
"I asked about stretching and he completely lied to my face and said it would not work for me.

"I was mostly trusting as I felt he was the expert who knew best in this regard so with a pinch of salt I accepted it."

Lesley has since read online reviews of this urologist which have made her question his competence.

One patient said she had been unable to work since having surgery for kidney problems, and he had "destroyed" her quality of life.

"I'm a mother of three young children who are scared every day I will die as they see me suffering in so much pain," she wrote.

"I can see how he misdiagnosed others, botched surgeries, and ruined lives,"
said another review. "He's dangerously incompetent."

Another review of Alex's urologist read:
"They left a surgical instrument in my bladder but I only got notified three months later.
Run away before you get hurt!"

Much to his regret, Alex was not able to research the urologist - or circumcision -
properly at the time because his laptop was broken.

He had tried researching the topic in a public computer space but felt uncomfortable,
and also felt it was "too much of a taboo" to discuss with friends.

So Alex booked what he believed was a minor procedure and
had the surgery in 2015, at the age of 21.

In the email to his mother, Alex explained, in
great detail, the physical problems he had suffered afterwards.

He described experiencing constant stimulation from the head of his penis,
which was no longer protected by his foreskin.

"These ever-present stimulated sensations from clothing friction are torture within themselves;
they have not subsided/normalised from years of exposure," he wrote.

"Imagine what would happen to an eyeball if the eyelid was amputated?"

"He was in so much pain that it hurt to do normal physical activity," says Lesley.
"He was a keen skier and snowboarder so you can imagine the pain he was in."

Alex also wrote about experiencing erectile dysfunction, and burning and itching sensations,
particularly from a scar which sat where his frenulum was removed.
The frenulum is a band of tissue where the foreskin attaches to the under surface of the penis.
Some men refer to it as their "banjo string".

"It's one of the more erogenous zones so it's thought to be important in sexual function," says Mr Dorkin.

"The foreskin, the head of the penis and the frenulum is a very, very sensitive area.

"But again when you do circumcision sometimes the frenulum is not preserved and
it doesn't necessarily have an effect on overall sexual function and enjoyment."

But Alex felt his frenulum had been important.

"Through its absence I can certainly verify it is
the most erogenously sensitive area of the penis and male body overall," he wrote.

"If someone were to amputate your clitoris you may begin to be able to understand how this feels."

He wrote about experiencing cramps and contractions in his muscles and
"uncomfortable" sensations which extended deep into his abdomen.

Lesley does not know whether or not Alex had sex after his circumcision.

"Where I once had a sexual organ I have now been left with a numb, botched stick," he wrote.
"My sexuality has been left in tatters."

He asked: "Nature knows best -
how can chopping off a section of healthy tissue improve nature's evolved design?"

The foreskin is sometimes dismissed as a "useless flap of skin", but
Consultant urological surgeon Trevor Dorkin, who is a member of the British Association of Urological Surgeons
says it does have a purpose.

"It covers the head of the penis," he says.
"In terms of what's it for, it provides a bit of protection to the head of the penis.
It's thought to have some sort of immunological function perhaps."

Only a week after Alex died,
a friend opened up to Lesley about his own circumcision.

"He told me he wouldn't normally have mentioned it but he had a circumcision as an older man,
10 years ago, and he was in constant daily pain," says Lesley.
"It just seems it's more common than you think."