To me it simply illustrate how far behind these ratings and some people are compared to reality. Anyone with access to the internet can find porn or naked people in less than 5 seconds or they can go watch a standard movie on Netflix and there is a good chance that there are a naked or partially naked person in it.
But in games, amongst all the cut off limbs and random killing, are you insane, don't even talk about it?
The rating system should simply state that a game is not for children, if it contains extreme violence, nudity and what other things that they find inappropriate and that's it. All the bullshit that the use of drugs, alcohol etc. encourage people to do this is absolutely false. It's not like GTA causes children to drive like maniacs on the street and shoot everyone on sight, because you can do it in that game.