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Content sum up: As you might have read, this game is full of intense violence, blood, gore, and sexual themes. This is definitely a game made for adults, and as such, I recommend it for ages 17+.

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Full content re-review coming soon...

Blood & Gore: The blood effects splatter and puff in moderate amounts when you and enemies are shot, hit or stabbed. Blood does linger; puddles on the floor; stains the characters' clothes; and there is static blood splattered on walls and floors throughout. However, it can be turned off at the title screen, under options, which will disable it for gameplay and cutscenes—static blood on floors and walls will remain.

Specific scenes of blood & gore:

An early scene depicts a group of soldiers being attacked by a swarm of hornets, showing one soldier's heavily swollen and disfigured face, as he drops dead. Later on, you find the villain who controls the hornets; he, too, is heavily disfigured from the years of taming them. After you defeat him, he explodes (for future reference, all the early bosses self-destruct after you defeat them).
Volgin (one of the main villains) has a heavily scared face—the majority of them appear to be from some sort of burn damage (he has an electric power).
A later boss is a derranged freak of a man in a space suit, who uses a superpowered flamethrower. After you defeat him, he bursts into flames, resulting in a detailed view of his suit and face decomposing under the fire.
Volgin is shown violently hitting a metal barrel, but something or someone must be in it, as the barrel starts leaking blood. He then knocks the barrel into the air revealing a dead and bloodied body—this was a failed attempt at interrogation.
A later scene shows Snake (the main character) come across a supposed ghost, while walking down a river. This ghost is a so-called spirit-medium soldier, and is a genuine freak, levitating around and shedding a tear of blood from his eye. He proceeds to lead Snake down a long narrow river, while showing Snake all of the enemies he supposedly killed. These supposed "victims" appear as several ghostly figures walking towards Snake from up river. Some have disfigured looks like broken necks and slit throats; you hear them screaming things they said before they died; and if the spirit-medium soldier hits you with his powers, you will see a brief, slightly disturbing image of his face flash on screen.
After defeating Volgin, he coughs up a moderate amount of blood on the floor. And when you defeat him the second time, he's bloodied with his old facial scars broken open--and then dies by, well, it's not nice to fool with Mother Nature.
Snake and Eva (the main female character) crash in a motorcycle. Snake lands on the ground, but she's not so lucky, landing on a log's sharp branch, which pierces abdomen clean through, resulting in visible blood trickling down her mouth and soaked into her clothes at the site of the wound—she then painfully pull herself off the branch (with appropriately sickening sound effects).

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Intense violence: this game is pretty much as violent as it can get, without crossing the line of a somewhat mild horror genre. Also it has some very bizarre almost mythological story elements, as in most characters have supernatual-like powers, ranging from controlling hornets with the mind to being a human lightning rod. Add all this and a load of complicated politics and theology, and you have Metal Gear Solid.

(Example of MGS weirdness: One of the bosses is just plain odd. He is supposedly over 100 years old, has his eyes bulging out of his head, and is technically dead most of the time, in order to save his life energy, and in turn, fight his enemies. After you defeat him, his dentures dramatically fly out of his mouth. Just weird.)

Snake can kill with an assortment of weapons, the most brutal being a knife, which if used will have your character stab or cut the enemy's throat. However, other than bosses, you don't have to kill in the game. You can use a non-lethal dart gun or sneak up on enemies and choke or knock them out until they go unconscious. Another one of the main gameplay mechanics is survival, which entails healing yourself by going into a pseudo-medical operation menu, and also killing animals such as snakes, rabbits, rats, birds and so on. There is no blood when you kill an animal, just a decomposition effect, and then a box of food representing the animal appears.

Specific scenes of intense violence:

(Listed below are the specific scenes of Intense violence. Many of these also have quite a bit of blood/gore in them. And although I could place these in the blood & gore category, I think they're more intensely violent than gory, and represent this category the most accurately.)

Ocelot (one of the main villains) shoots and kills a half dozen rival soldiers (all with appropriate blood effects). When he gets to the last man lying half dead on the ground, he finishes him off by shooting him in the head.
A main villain breaks Snake's arms, resulting in the arm contorting and a sickening crunch—you later see him reset it with an agonizing scream.
Later on, Snake is caught by Volgin. Volgin proceeds to beat Snake to a bloody pulp; smashing his head onto the wall, kicking his ribs in, and headbutting him several times, visibly damaging Snake's face (open cuts and bruises) in the process, with all the while Snake making appropriately painful gurgling noises.
Right after, Snake wakes up in what appears to be a torture room, with dried blood stained all over the walls and floor. He apparently has a plastic bag tied over his head because at first you can't see, but only hear as Snake screams in agony from being kicked and hit repeatedly (bone-crunching sounds included). The camera then switches to a third person view, where you see that Snake does indeed have plastic bag over his head, making it hard for him to breath. Volgin then proceeds to splashes a bucket of water on Snake and electrocute him with his powers (resulting in more scream from Snake and smoke searing from his body). Ocelot then steps in and attempts to intimidate Snake by shooting in his the vicinity, eventually (and believe it or not, accidentally) shooting out Snake's right eye, resulting in blood spurting from his socket.

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Language: There are under a dozen uses of d*mn and hell, and one use of, b*tch, bastard and SoB. Other than the main script, when Snake eats certain items he'll often say, "that's d*mn good!"; one boss frequently says, "Son of a b*tch!" while you fight; another boss will say, "D*mn!" and "Burn in hell" when you damage him, and Eva will taunt the villain by saying, "Come and get me dumb a**!"

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Sexual Themes: There are several posters of bikini/lingerie clad women scattered throughout the game; some are obvious and others are somewhat hidden. You can also use girly magazines to distract guards, by setting them on the floor.

Eva wears a revealing bikini under her jumpsuit, and throughout the game, she flirts heavily with Snake. She's implemented with breast physics—making her chest noticably bounce. And in a few cutscenes, you have the option to look at Eva in first-person mode, and a couple instances, show angles of her slowly slipping her jumpsuit back on, with bikini and breast physics in full view.
Ocelot holds Eva at knife point. She's wearing a baggy jumpsuit and helmet, so when he touches her chest he realizes she's a girl—it's not for erotic reasons.
Volgin, is a twisted, derranged pervert. Throughout the game, it is suggested that he uses one of the female characters as a sex slave. It is also suggested that Volgin is bisexual, and is having a relationship with a male subordinant. In fact at one point, Snake is disguised as this subordinant, and when Volgin feels for Snake's crotch, he immediately knows that Snake isn't his soldier lover.
A later scene shows as Eva starts to kiss Snake. She slowly starts to zip down her jumpsuit, revealing her scant bikini top—he rejects her and the scene ends.
Another scene shows as Eva starts flirting with Snake again; this time she's only in her bikini. She starts to crawl on all fours towards him (very noticeable breast physics in play) tries kissing him—again he rejects her advances.
In a later part of the game, Eva is heavily injured. Earlier I briefly mentioned the cure menu. You have to patch up Eva with this menu. The menu shows the character and what injuries they have on screen. It also has an x-ray view of the body that shows the skeleton and a transparent view of the overall body shape. Well, since she is female you do see the outline of her breasts, nipples and buttocks, and there are breast physics in play, so she does bounce. But again, it is mostly a view of the skeleton, so it isn't too erotic or appealing.
A later scene shows Eva and Snake making out and straddling each other on the floor. It is suggested they sleep together (although it doesn't show anything).
Also, something that could be considered crude humor, is a scene where Ocelot plays Russian Roulette with a scientist. making the scientist eventually wet himself with fear (obviously not sexual, but I had to fit it in somewhere ;P).

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Use of tobacco: (The ESRB didn't mention this in their rating--and I don't know why, as this is one of the main traits of the main character) At the beginning of the game, Snake is seen smoking a cigar; and cigarettes are selectable from the inventory, but they're seen as a negative, and if selected, start to slowly suck your health away.

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