It's a television series, it's not real. Nobody's actually getting flayed. Basically consider it a theatrical sound effect. Did it + the animation generate a reaction, yes... kind of the same "that's gotta hurt" reaction to various fictional portrayals of violence. Nausea? No. Save it for real-world situations.
The scream was no more "real" than the screams heard in horror films. It's real in the sense that yes, it is a woman screaming. It's not real in sense that it was created purely as sound effect.
People can temper their reactions to things based on context.
The one thing I've never quite figured out in the episode is how that guy came into contact with those women. The first situation seems to have started out somewhat consensual up until the point where the guy says his plan/intention is terror. The situation with the woman found alive definitely does not appear consensual in any way.
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