Snake can equip and smoke a signature cigar item that advances in-game time as a gameplay effect.
The plot depicts revenge, child soldiers, and a quarantine scene in which the player must shoot their own infected, pleading comrades.
Real money buys MB Coins that grant resources and speed up base and Forward Operating Base development, affecting play.
Wartime dialogue includes moderate profanity such as 'shit' and 'bastard'.
Realistic third-person combat against human soldiers with blood on hits and bodies that remain on the ground; the player can also subdue enemies non-lethally with tranquilizers.
The companion Quiet wears a torn, minimal outfit that exposes much of her body; no explicit nudity is shown.
A scene depicts a soldier attempting to sexually assault the captive Quiet before she fights him off.
Body horror is shown as subject matter, including shrapnel lodged in the protagonist's skull and parasite deaths with bleeding from the throat.
Base and weapon development run on real-time timers that MB Coins can shorten or skip.
Supernatural enemies such as a burning man and a floating child appear in dark, unsettling sequences.
Wild animals can be tranquilized, extracted, or killed as ordinary field play.
Torture is referenced in dialogue and recovered audio recordings within the story.
A supporting sniper character is presented with suggestive camera framing and attraction is implied; no sexual activity is shown.
Metal Gear Solid V: The Phantom Pain is an open-world stealth action-adventure set in 1984, following the mercenary Venom Snake across Soviet-occupied Afghanistan and central Africa on a mission of revenge. Players infiltrate enemy outposts using a large toolkit of weapons and gadgets, choosing between quiet, non-lethal approaches and open gunfights, while building and managing a private army from a home base. Combat is realistic with blood but little gore in ordinary play; heavier body horror surfaces in cutscenes, including a graphic hospital prologue and a parasite that ruptures soldiers' bodies. The game carries intense subject matter such as child soldiers, war atrocities, and a forced execution of one's own infected troops. A revealing companion character, an attempted assault scene, moderate profanity, and a usable cigar item are also present. Online play pits players against strangers through base invasions, and real-money purchases can speed development and buy resources.
The game frames its violence as tactical infiltration and repeatedly rewards restraint, offering non-lethal tools and treating a fully undetected run as the ideal. Its story dwells on the cost of war and revenge, presenting child soldiers, betrayal, and the killing of one's own men as tragedy rather than spectacle, with the darkest acts shown as painful burdens carried by the characters.
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