The film's score is (at times) very unsettling and tense.
There are constant flashbacks to where a woman gets the sides of her mouth cut open, and this is really frightening and upsetting to watch. The build-up is very tense, though we only actually see what happens explicitly once later in the film.
At the beginning of the film we see the bloody aftermath of what happened. It is big shock for the viewer as the shot comes out of nowhere and is extremely disturbing, as the woman is screaming and clearly distressed, as well as being soaked in her own blood.
It's very upsetting when one of the women dies of syphilis.