The instrumental demos were primarily written in major chords , which Byrne considered slightly "ominous" and surprising from Eno.  In spite of this, Byrne's lyrics ended up being hopeful and spiritual,  with themes of redemption  —what he considers "optimism in spite of the dread."  The tension between optimism and pessimism  and the spiritual themes quickly emerged over the course of a year in which Byrne was writing lyrics,  which he has speculated might be an antidote to being "completely pessimistic and cynical about politics and the state of the world;"  for instance, "The River"  is about the effects of Hurricane Katrina .  He has also cited the political climate of the Iraq War , the beginning of the late-2000s recession ,  the policies of the George W. Bush administration ,  and his 2004 divorce from Adelle Lutz  as factors that inspired him to create uplifting music. As he explained, "I was surprised that's what came out... The tracks are very different from what I would have done myself. I lean toward things that are more complicated." Eno also thinks the album is much better than the songs he imagined when composing them solo. 
The untrained insertion of foreign bodies into the urethra carries a significant risk that subsequent medical attention may be required. Documented cases of urethral intercourse appear to have occurred between heterosexual couples; a survey of the global medical literature available in 1965 reported accounts of thirteen separate cases.  By 2014, 26 cases had been documented in the medical literature, many in people with Müllerian dysgenesis who were engaging in urethral intercourse unknowingly.  However, the stretching of the urethra required by this form of intercourse has also reportedly resulted in a complete and permanent loss of urethral sphincter control ( urinary incontinence ); furthermore such intercourse presents a very high risk of bladder infection to the receptive partner.   It can also lead to permanent dilation of the urethra and incontinence during intercourse. Presenting symptoms of unintentional urethral intercourse include primary infertility , dyspareunia (pain during intercourse), and incontinence.  A case of urethral intercourse with penile penetration is mentioned in Bonk: The Curious Coupling of Science and Sex by Mary Roach .  More serious consequences include evisceration via the urethra and bladder rupture .