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This was printed in Playboy magazine in April 2001.
It's hard to explain to people who weren't around back then how loose the "rules" were for making games. Conker's Bad Fur Day was definitely trying to market itself as edgy, but aside from some faith-based groups who would be upset, nobody really cared.
+1 basically went through the same mental process.
FWIW, I don't have a problem with adult content on game stores, hell I think we should be more chill about it, but let's call a spade a spade and say what it is. Better yet, separate it into its own category that you can lock or something. Whoever approved it clearly doesn't care.
I'm not sure how you could get any more explicit and direct than 'real hentai'.
I mean the fact that it's mixed in with all the other games and not in a T&A section.