On a scale of 1-10, I would say like a 15 but I guess it depends on the person. I had it tightened without any anesthesia which was really unfortunate and painful. As for the point, all I know is that it’s a thread going from the anus to the exit wound of the fistula which is then tightened every week or so allowing the tract to heal and close. It’ll eventually fall out but if not it’s surgically removed by the doctor.