Pucker Up

No, Not Those Lips

I got older last weekend. Technically we all got older last weekend, but in my case the numbers changed. It was a good birthday. Friends refused to let me wallow in my post-election, post-walking-pneumonia, midcourse-antibiotic haze. They insisted on celebrating, and it was just what I needed.

One friend shared her Reiki talents on my tense shoulders and tight jaw. Another shared her expertise in information technologies. She promises me that writing this newsletter in our new Trump-era isn’t just preaching to the choir, or rather that preaching to the choir in times of chaos is an important task because it keeps people up-to-date and motivated and adds accurate information to the digital pile. Other friends shared cake and prosecco and made me laugh. 

I want to thank them, and I want to thank you for sticking with me as I write and rant. I heard from more people than usual through comments and emails after I posted last week’s vaguely shell-shocked edition. Like my birthday celebrations, your messages also gave me a sense of community that I need right now. Let’s keep that going. Please like, comment, email, or use the notes function on the Substack app to share what you’re thinking and feeling as the new world unfolds. And, of course, forward the newsletter to anyone you know who might also appreciate the sex and snark combo for the next few years.

We’re going to have a lot to talk about. RFK Jr. alone will give us a daily dose of “that’s not how it f**king works,” and there’s so much to unpack in the purposeful irony of an adjudicated sex offender nominating a suspected sex trafficker to lead the Justice Department where he may be in charge of efforts to revive the long-dormant anti-sex Comstock law. That’s before we even mention the potential Secretary of Defense who thinks women don’t belong in combat because it’s too distracting to men, or the old allegations of sexual assault against him that surprise exactly no one. While I was writing we added Dr. Oz to the clown car. There was a study a number of years ago that found the information on his show was less accurate than that on Disney Jr.’s Doc McStuffins.

Ginger, get the popcorn!

New STI Data is Not All Bad

The CDC messaging around the agency’s newly released STI data for 2023 points to glimmers of hope and stresses cautious optimism. It’s hard to remain hopeful when congenital syphilis is still rampant, a new more serious strain of mpox has landed in California, and our infectious disease tracking and prevention system is about to be handed over to someone who’d like us to stop vaccinating for measles. Nonetheless, I agree that this news is not all bad.

According to the 2023 Sexually Transmitted Infections Surveillance report released last week, there were fewer STIs reported in the United States last year than the year before. Gonorrhea rates fell, chlamydia rates remained stable, and syphilis rates leveled off with only a 1% increase.

The report focuses on those three STIs because they’re reportable, meaning the CDC must be told about all diagnosed cases. In 2023 there were 2.4 million of them. That represents a 1.8% decrease from 2022. Much of this decline was the result of a 7% decrease in the number of gonorrhea cases. There was also a 10% drop in the number of early stage (known as primary and secondary) syphilis cases, though total syphilis cases (which include late stage and congenital cases) squeaked up by 1%. And while congenital syphilis rates went up, the 3% increase year-over-year pales in comparison to the 30% jumps we had been seeing. 

As always, though, there are wide disparities in who gets STIs. Young people remain the age group hardest hit with 48.2% of reported cases occurring in those ages 15 to 24. Already marginalized communities are also hit harder by STIs. In 2023, MSM accounted for 57.5% of primary and secondary syphilis cases among men with known sex of sex partners. In addition, 32.4% of all cases of chlamydia, gonorrhea, and primary and secondary syphilis were among non-Hispanic Black or African American persons, even though they made up only 12.6% of the U.S. population. Like in previous years, cases of congenital syphilis were highest among American Indian or Alaska Native persons.

While it may be tempting to pass judgement and dust off those Comstock laws, it’s important to remember that getting an STI has more to do with sexual networks (who you’re having sex with and who they’re having sex with) than individual behavior. Sexual networks have more to do with societal factors like poverty, stigma, racism, and lack of access to health care than personal behavior. For example, gonorrhea will likely spread more widely within a sexual network made up of people who are uninsured because it’s less likely that they will get screened and treated quickly.

It does seem like we’ve made progress in addressing the rise in STI cases. Experts credit increased testing (including the availability of at-home testing), and the introduction of doxy PEP (the use of doxycycline to prevent bacterial STIs) with helping to curb the epidemic. But we still have a long way to go at a time when the future of all public health efforts seems perilous, and programs to help with poverty, stigma, racism, and lack of access to health care seem destined for the dust heap.   

Puff Up Those Lips, No the Other Ones

In 1986, model/actress Kelly LeBrock appeared on our television screens in a blue, sequined dress with an enormous mane of hair and said, “Don’t hate me because I’m beautiful.” The ad was for Pantene and promised that if we just switched shampoo and conditioner, we could be beautiful too. As it turned out, however, it wasn’t her hair we wanted. Big 80s hair is out, but big lips like LeBrock’s are very, very in. 

People have been filling their kissers with various materials since the early 1900s. It started with fat and moved to liquid paraffins, silicone, and bovine collagen (say moo!). With the advent of human collagen in the 1990s, lip fillers got safer and easier, but they were still seen as a frivolous or fringe beauty ritual. In the First Wives Club, released in 1996, Goldie Hawn’s character has to beg her plastic surgeon for the procedure. The lips she leaves his office with are meant to be comically large, and she’s laughed at by her friends in a subsequent scene. By today’s standard, they practically look scrawny.

Lip fillers really took off in 2015 because of synthetic hyaluronic acid and Kylie Jenner. The American Society of Plastic Surgeons reports that inquiries for the procedure soared as soon as the model/Kardashian admitted she’d had the procedure. That year alone, 27,000 Americans got the procedure. (When I bemoaned that a Kardashian had that much influence on our society, my husband pointed out that following the stylings of a world-famous model is not new and pointed to my fifth-grade Farah Fawcett haircut as proof. If anyone cares, my fine hair does not feather no matter how much AquaNet is involved.)

It turns out that these are not the only lips people wanted to make bigger. According to a recent article in Allure, labia puffing has become a thing. Admittedly, it’s not clear how big of a thing it’s become as we have no hard data, but one Connecticut plastic surgeon says she’s asked about the procedure at least every two weeks. The surgeon believes, “One day it’s going to be a household type of thing, where we talk about it the way we talk about breast implants.”

I’m not convinced, but I am a little disturbed.

A quick refresher on the anatomy of a vulva before we proceed.

The labia majora are the outside lips which are covered in hair if you’re post-pubescent and haven’t visited your waxer recently. The labia minora are made of more sensitive, hairless skin and cover/protect the clitoris, urethra, and vaginal opening.

There is a lot of vulva variation including shape, color, fullness, and size. Some people have very dark inner lips. Some have pink ones. For some the inner lips hang loose and low. For other they are barely visible. The way our vulva looks also changes multiple times in our life as we grow, go through puberty, make hormones, get pregnant, give birth, gain weight, lose hormones, go through menopause, etc.

Like with all other body parts, there is a standard of beauty associated with the vulva that does not encompass the wide variation in what is normal. Since most of us don’t look at random people’s vulvas each day for comparison, porn is often blamed for pushing one particular vulvar variety. Today’s porn seems to prefer vulvas that have small inner lips that are tucked neatly under hairless outer lips. (We can discuss whether this represents a preference for prepubescence another time.) This standard could change, of course, 70s porn was all about the full bush.

Over the last decade or so, there has been an increase in labiaplasty, a surgical procedure that alters the vulva. Most often this procedure is used to shorten the labia minora so that they don’t hang “too low.”

When I was teaching college-level sexuality courses, I would watch a British documentary on vulvas with my students. One young person featured in the film said she got made fun of for her long labia minora and desperately wanted them to be trimmed down. The film shows her getting exactly that. The procedure is done in the doctor’s office under nothing more than a shot of local anesthetic. It was the only trigger warning I ever gave to my students because once you see someone crying in pain as they have a piece of their vulva voluntarily cut off, you can never unsee it.

Labia puffing involves the other vulvar lips. Apparently, while we’re supposed to want short, neat inner lips, the outer ones are supposed to greet the world with some plump and circumstance. According to the Connecticut plastic surgeon, young women ask for the procedure because they find their outer lips “underwhelming” while older patients are often distressed by fullness lost to the aging process. As one patient told Allure, “My vagina was looking like a very old, worn-out gym sock.”

The procedure is simple. A plastic surgeon numbs the area with cream and injects one or more syringes worth of filler into the labia majora. (Dr. Connecticut says most people won’t want any more than six syringes because they’d get a “huge camel toe.”) This is an off-label use of fillers like Juvederm or Restylane as the FDA has not approved these products for genital use, but most doctors agree that it’s safe.

Necessary is another question.

I recently saw the comedienne lliza Schlessinger perform in New York City. (If you haven’t heard of her, I totally recommend her series of Netflix specials including Elder Millennial.)  One of her new bits starts with the assertion that she will never make fun of women for getting plastic surgery no matter how unnatural the outcome looks because our society holds women to an impossible standard of beauty. It’s not fair to punish us for trying to achieve it. The doctors who earn oodles of money performing such surgeries and the companies (pharma and cosmetic) that profit off of our insecurities, however, are totally fair game. (The rant includes a very funny bit of physical comedy about lipstick for your asshole as a Shark Tank product. Watch the show when it comes out on Amazon Prime.)

I’m a woman of a certain age (older than I was last week as I noted earlier), and I’m kind of liking the wrinkles and laugh lines that are developing on my face though I could live without the sagging chin. I find preternaturally smooth foreheads and over-inflated lips to be off putting when I look at someone. I was relieved when older actresses like Courtney Cox and Kristen Davis admitted the results were not what they’d hoped. But I’m trying to be less judgey and really appreciate Schlessinger’s point of view. No one chooses this in a vacuum.

My initial instinct is that vulvas are different. First because they’re so sensitive. Over the years, I’ve had shots to numb the area for procedures, not to mention two episiotomies, and the thought of having three or four syringes full of anything injected there makes me want to cross my legs really tight. And second because so few people in our lives see our vulvas. In my ideal world anyone you’d be willing to show your vulva to would be thrilled to see it no matter what it looked like.   

But I’m trying to be less judgey in my older, wiser years. No one chooses this in a vacuum either. So go ahead and plump up the jam, puff the pastry, stuff the clam, inflate the water wings, soak those lady fingers, or blow up the bouncy the castle (the possibility for euphemisms is truly endless).