The ESRB’s rating is not a surprise; its ratings description is a barrel of jolly time fun, though. Sounds like you can visit ye olde cat-house and click an “I’m feeling lucky” button when the madam asks you what you like. That means players “can sometimes wind up face-to-face with a woman, a man, a transsexual, or an animal,” according to the ESRB. “Sexual activity is never depicted during these brothel encounters.” Drat.
“Players can also initiate brief cutscene sequences in which couples (male and female or same sex couples) can be depicted kissing, embracing, and caressing one another as the screen fades to black,” says the ESRB. However – there’s zero nudity, except for a pair of demon tits, and that’s not enough to get it flagged.