No nudity amounts to a sort of a fig leaf look, if that makes sense.
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I don't think it being single player amounts to the same thing as privacy. It's a game sold to the public. Sex is a known part of the game. It's seen in streams, it's seen in articles. It's not private in the sense that it's not a physical act shared between two people behind closed doors and closed lips.
Imagine if the folks on Little House on the Prairie sat down to play this game. They would see it as lustful and consider it to be a sign of degeneracy. Whereas they had to slaughter pigs. They had to fight to survive.
Violence wasn't praised, but it wasn't shied away from. Sex on the other hand wasn't a commercial product like it is now. There is an intrinsic difference in the way they are portrayed for a reason.
You could, of course, argue that brothels existed, but those were considered sinful.
