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As mentioned above, the animal killings in the Italian cannibal genre are exceptionally hard to stomach (but are sadly essential to give the likes of Cannibal Holocaust their "edge" over other jungle capers).
Slaughterhouse footage from many mondo compilations is similarly distressing (yet I eat meat, so I'll sit with the rest of you hypocrites).
The protracted stabbing sequence from Saving Private Ryan is very ugly, as are the baseball bat-attacks and head-vicing in Casino.
As far as out-and-out exploitation movies go, there are far too many contientious scenes to mention.
Try the erect cock/suicide scene from the end of Nekromantik - incredible how such a challenging scenario is made so cinematic by Jorg Buttregeit's direction and the fabulous soundtrack.
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