ESRB rating for Tsukihime: A Piece of Blue Glass Moon sheds new light on the title

This is a visual novel in which players follow the story of a high-school student who encounters vampires and ghouls in Japan. As players progress through the narrative, they view stylized story sequences (mostly still images), some depicting violence and blood: blood splatter; pools of blood; characters killed off camera; a character’s hand repeatedly stabbed. The text includes descriptive details of violent acts (e.g., “I stab, I cut, I slice, I carve. Severing piece after piece until nothing is left…”; “After listening to the weakling beg for its life, she begins her meticulous work…Once the other arm is gone too, she swaps her tools and sets work on its inside.”). Some sequences depict severed limbs and dismembered body parts in large pools of blood. A female vampire is depicted partially nude, with exposed pelvic area (no genitalia), and her arm covering her breasts. The words “f*k” and “sht” are heard in the game.