This game contains depictions of sexual activity with visible genital organs. Throughout the game, there are multiple scenes showing sexual activity and strong sexual themes, including a ‘sex minigame’ where the player must repeatedly press a button to fill a satisfaction bar. Though the characters are pixelated and non-human, genitalia is visible. Another notable scene shows a character masturbating, whilst he watches another character sexually thrusting an apparently deceased, fantastical character. Actions within Netherworld are mitigated by the games art-style, which restricts the clarity of the actions described. In addition, characters featured in the game are fantastical and do not resemble humans.

This game also contains encouragement, glamorization or prominent promotion of the use of controlled substances. Players can take part in a drinking game, where drinks are being slid to the player character and an opponent, and the winner must drink more than the other. When the player drinks, the screen becomes progressively blurry and distorted. On winning, an achievement appears which says ‘You’re wasted. Congratulations.’. In addition to glamourisation of alcohol, there are multiple instances where players can purchase and consume alcohol, as well as many frequent dialogue references to the player character being an alcoholic.

This game contains strong language such as ‘fuck’, as well as milder terms such as ‘bitch’, ‘shit’, ‘whore’ and ‘bastard’.