Fear and Hunger is a contender. If you aren’t aware, imagine a JRPG where you kill god at the end, but you don’t ever level up. Also the first enemy you fight is very likely to kill you, and has just as much of a chance of doing so on your 100th playthrough. Oh, and you start from the beginning every time you die.
I haven’t played it myself, but I understand there are mods to remove nudity at least, and I would expect the sexual violence as well. That would be a requirement for me to try it.