She built her reputation on shocking her audience. She's merely run out of things to shock and repulse people with and therefore is doing something rather desperate.
Regards, Ivan
If she really wants to shock her fans, she could put on say 20+ pounds, come out on stage wearing more than her underwear & sing songs middle aged women could relate to - about dragging kids around in minivans to sports & ballet & music lessons while trying to keep up w/ the dirty laundry, clean the bathroom, and cook dinner. All while having hot flashes and having a groups of real mean background dancers, resembling Larry the Cable Guy, shirtless, with beer guts swaying the rhythm.
That would be shocking (and true to her age!)