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I suppose it depends on how deeply rooted these elements are in your game. If you think about stuff like voice acting, you'd have to pay voice actors extra to record extra lines. If your game has certain animations (be it hand-drawn or modeled), you'd have to pay animators extra too. Oh, and if the writing in your game has certain scenes, they either need to be rewritten or circumvented otherwise. If it's just something simple as a profanity filter, then it's relatively easy and cheap to do, but not if you'd have to remake whole parts of a game. This is especially cumbersome if you allow a scale, for example from full nudity to no nudity at all, you could also have different degrees of nudity.