It might not be a surprise to hear that Metal Gear Solid V: Ground Zeroes has been given an M rating by the ESRB, but the US regulatory group has also specially warned that some of the game's content features sexual violence.
An ESRB representative told GameSpot that Metal Gear Solid V: Ground Zeroes is the second game to get the "sexual violence" content descriptor. The first was Animamundi: Dark Alchemist, a visual novel released for the PC back in 2006.
Warning: some Metal Gear Solid V spoilers follow.
The ESRB describes the game's content as featuring "blood and gore, intense violence, sexual violence, and strong language," with its ratings summary giving an indication as to the off-screen events events that warranted the warning.
"This is an action game in which players assume the role of an elite soldier through military missions in Cuba," wrote the ESRB. "Players infiltrate various bases and use pistols, machine guns, and rocket launchers to kill enemy soldiers. Firefights are highlighted by realistic gunfire, slow-motion effects, and large blood-splatter effects. Players can also employ stealth attacks (e.g., choking, knife stabbing from behind) and have the ability kill non-adversary characters/prisoners. One cutscene includes a depiction of blood and gore (e.g., a character's intestines exposed during a dramatic procedure to remove an object). The game includes an audio file in which a female character is sexually assaulted by male characters; while there is no visual depiction, sounds of ripped clothing and struggle can be heard. The words 'f**k' and 'sh*t' are heard in the dialogue."
Though it's not clear which characters are depicted in these scenes, fan speculation on Reddit has suggested that the scantily-clad sniper Quiet could be the victim of these attacks. Following criticism over Quiet's choice of outfit, MGS director Hideo Kojima said there was more than meets the eye to the character.