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The bigger issue is that there are a few topics that the story explores that are of a sexual nature. I don't really wanna explain it because potential spoilers, but it is used for drama with shocking effect. Nothing is explicitly shown, but very dark topics are discussed that don't usually show up in video games.
Think about how sexual themes are used in a super serious, grimdark live action drama. It's kinda more like that than Dead or Alive Extreme, if that makes any sense. lol
Non-spoiler version: In addition to one particularly fan-servicey scene, the backstory of one of the characters is heavily and quite disturbingly rooted in "sexual content." In my personal view, it's at a level that pushes even the M / 17+ rating the game originally received. The fact that it's not visual is likely what saved it from being AO type of material honestly.
Spoiler version: Kotoko Utsugi has a deep rooted history of child sexual abuse. Alongside being a child actress, she was frequently sold into prostitution, often by/with her mother as a pair. She is extremely triggered by the word "gentle" as the men who abused her would say that they would be gentle with her. At several points, her triggers are used by Monaca as a control device. Overall, it's an extremely dark backstory for a character and one that definitely pushes boundaries.