A is for Alex is a mother’s account of grief after the suicide of her 23-year-old son due to complications resulting from his adult circumcision. In 141 pages, author Lesley Roberts tells the story of Alex’s childhood, his death, and the grief she experienced as a result. The book is about not only Alex’s circumcision but also his mother’s grief, and it provides a sobering reminder of the stakes of circumcision and the consequences of our society’s ambivalence towards the procedure.

Alex was living in Canada in 2015 when he visited his doctor because he was suffering from phimosis, a medical condition in which the foreskin is too tight to retract behind the head of the penis. The doctor recommended steroid creams and stretching, but Alex felt poorly instructed on how to use them. After a few weeks of no results, the doctor referred him to a urologist who recommended circumcision. Once again, Alex felt insufficiently informed on the risks of the procedure and its less invasive alternatives, such as preputioplasty, a procedure which widens the tight foreskin. By his own admission, he did not do sufficient research into the procedure, instead placing his trust in the overconfidence of the surgeon.

Alex greatly regretted the surgery. In an eloquent and chilling letter by Alex himself, reproduced in chapter seven of A is for Alex, he describes the negative effects of his circumcision that eventually led him to take his own life. He likens the removal of the foreskin to the removal of one’s eyelid, constantly open to irritation without the skin that was designed to protect it, and writes “I once lived in color, but now I exist in monochrome.” His words effectively communicate the absolute grief that drove him to his death, and the resolve to change how we view and discuss circumcision so that no one else has to go through the suffering he did.

The author’s account of her grief after Alex’s death is also deeply moving. She spends time describing Alex’s childhood and who he was as a person. Her deep love for her son is felt in her writing, as is her deep grief at his loss. At times repetitive or cyclical, her testimony beautifully demonstrates the non-linearity of grief. She frequently meditates on happy memories of life with her son and the bleak period after his death, when the color drained from her own life. The book succeeds in communicating the raw pain of a grieving mother.

It also succeeds in providing an emotional reason not only to oppose circumcision as a modern medical practice, but to work towards dispelling taboos around circumcision and suicide. Alex writes that the taboos surrounding circumcision and sexual health are why he felt he had to go it alone in both deciding to have his circumcision and in dealing with its outcomes. This reality is true for many, and it is why breaking down these taboos and facilitating discussion is an important piece of the progress that must be realized if we want to end the injustices of circumcision. Lesley Roberts has become an ambassador for 15 Square, an organization which promotes research, accurate health information, and informed consent regarding circumcision.

Lesley Roberts also writes directly about her son’s suicide and her journey with grief afterwards. Chapter 10 gives practical advice for those who wish to support someone in a similar situation, and also details the ways that the taboo surrounding suicide has amplified her suffering. The book emphasizes the importance of talking about suicide and how to do so, aiming, like Alex’s letter, to increase understanding and reduce the suffering of those who follow.

A is for Alex is not an easy read, but it is a moving one. The book tells the story of a son who felt his life was destroyed by circumcision, and his mother who is left with the immense pain only a parent can feel. It includes valuable discussion on tragically under-discussed topics and can personally inform and contextualize the broader discussions of both circumcision and suicide prevention.