Yes, intent is a fundamental difference, but has absolutely nothing to do with the experience of the recipient. Without the anesthesia, there is no physical difference in the sensation, the fear, or the physical trauma inflicted, other than the surgeon will have a more aesthetically acceptable technique.
Except intent has everything to do with this comparison. Modern medicine has identified the brain and its effect on the body as being a physical system. Intent would affect how a person copes with the immediate physical trauma of surgery versus torture. Intent would also affect the brain's ability to heal the physical body afterward.
Somebody has to do this, and so I guess I will... The main difference between rape and consensual sex is intent. Oftentimes there is no difference in the immediate physical trauma inflicted. Because of intent, rape is extremely damaging (mentally and thus physically), while consensual sex is typically healthy.
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