Fuck the gods there's so much pearl clutching in these reviews. I personally was unphased by all the graphic shit (I'm a fan of Hannibal, after all) - the book was just a slog.  I didn't like the main character, which is not a good thing for a book written in 1st person. It's honestly a testament to how good the writing itself was that I felt compelled to keep going and finish.

In short, I'm a plot-driven bitch, and plot was thin on the ground (in favor of lore and mythos), which is what made it a slog for me.