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If the problematic content isn’t crucial part of the game, they can try to go for the “official 18+ patch” like some VN re-releases, which would be like adding a peanut in a separate box
Absolutely, have the game without it and a free (or with a stupid price like 10 cents just to ensure legal age requirements) DLC that’s parked as adult only. But I think in this case it might be too engrained to the core of what the game is, that they can’t, and if that’s the case it makes sense to mark the entire game as adult IMO