Content review for this game:
Pertaining to the ESRB rating.

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Content sum up: This contains plenty of blood, gore, language, and suggestive themes on par with an R-rated movie. So I recommend it for ages 17+.

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Blood and gore: There is a moderate amount of blood in this game, mostly in the form of puffs and spurts when you or enemies are shot, hit or stabbed. Blood does lingers in puddles and stains the characters' clothes. However, it can be turned off at the title screen, under options, which will disable it for gameplay and cutscenes. Dispatched enemy bodies do linger, and you see several dead, bloodied enemy and allied soldiers' bodies scattered throughout the game. There's also some moderate gore, which the ESRB didn't mention in their rating.

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Specific scenes of blood & gore:

The opening scene seems to be ripped straight from an action war movie, and shows dozens of soldiers fighting in a middle eastern setting. When the firefight breaks out, many of the soldiers are shot (with appropriate blood effects) in the head, chest, neck, etc. And as Snake (the main character) is making his way through the chaos, three large, bipedal half organic/machines (which resemble AT-STs from Star Wars), called Gekko, show up, and start attacking soldiers. As the Gekko jump in, one lands on and crushes a soldier resulting in some blood spurting, and then the Gekko start to massacre every soldier in sight. While Snake tries to evade the Gekko, he stops in a building to take a breather. As he's resting, three drops of blood fall on his shoulder. When he looks up he sees a Gekko standing over him, holding a dead, bloodied soldier in its jaws. The Gekko then tosses the body aside, and starts to pursue Snake. Snake proceeds to shoot the Gekko in its organic legs (weak point) several times, resulting in it shedding some blood, but to no avail, as it gets up and continues to chase him.
The B&Bs (Beauty and the Beast, explained later) make their first appearance, and start to attack Snake's allied soldiers. The first beast grabs a soldier with its tentacles and squeezes until he is crushed (with appropriate blood & sound effects); the second beast uses the body of another soldier to shoot and kill four of his fellow soldiers (with moderate blood effects), and finishes him off by breaking his spine with her mind; and the beast with tentacles uses one to pierce a soldier all the way through his mid-section (with you seeing/hearing the bloody impact), lift him in the air, and smash him to the ground.
Vamp (a main villain) and one of the B&B look for Snake among soldiers. The beast tells Vamp that Snake isn't with them, so Vamp gestures to her to kill them. She grabs and smashes one soldier to the floor, and then uses her tentacle to pierce through the second soldier's body, with bloody results.
Snake finds Vamp with a few enemy soldiers, and Naomi (a main character), who Snake is there to rescue. Vamp is about to extract Naomi by helicopter, when Snake finds a opening and shoots Vamp square in the forehead, resulting in blood splattering as you see the impact. He however, doesn't die (as he's supposedly immortal), and instead falls to the floor and loses consciousness.
Later when Snake, Drebin and Naomi escape the area, they wait for Otacon (a main character) to extract them by helicopter. But, as they wait, several more Gekko close in on their position. When their situation seems dire, Raiden (main character from MGS2) comes in and starts to dispatch dozens of Gekko with his sword. Since the Gekko are part organic and their legs are their weak point, Raiden uses this to his advantage and starts cutting away. As a result, you see plenty off blood spurt from their legs (and what's left of the muscle tissue and bone), as he slices 'n dices, stabs and severs them with his sword. He proceeds to do this for a couple of minutes while Snake, Otacon, and Naomi fly over in the helicopter to pick him up. As they reach his location, Vamp shows up and makes his way toward Raiden. The Gekko have pinned Raiden with several cords, rendering Raiden immobile. As he tries to free himself from the bonds, Vamp reaches him, pulls out his knife and stabs Raiden in the chest. When Vamp pulls it out, the blood Raiden sheds isn't red, and instead is white--it's made out of synthetic material as Raiden is now part cyborg/human and in full body armor. Vamp then slowly grazes his knife across Raiden's upper body and then again plunges it into Raiden's chest. Snake, seeing Raiden is in trouble, shoots one of the cords, freeing Raiden. He (Raiden) then immediately engages in battle with Vamp while simultaneously dealing with the Gekko that get in his way. Vamp stabs Raiden many more times in the chest and feet, resulting in more white blood, but supposedly not much ill-effect. They continue to battle as Raiden manages to stab Vamp multiple times in the upper chest and neck with a knife attached to his feet (Vamp sheds red blood as you hear squishing sounds). Vamp then takes one of the knives still stuck in his chest, chuckles and (with bloody results) pushes it all the way through to his back, and places the knife in his holster. Vamp then knocks Raiden over and dances on his chest with clawed feet (as you hear the crushing sounds). Raiden manages to get up, and after a bit of dodging, Vamp grabs Raiden from behind and starts to choke him. Raiden then takes his sword and runs both himself and Vamp through. Eventually Raiden withdraws the sword and as they turn around they stab each other; Vamp with a knife to Raiden's side, and Raiden with a sword through Vamp's middle. The battle then ends as Vamp falls unconcious and Raiden escapes by helicopter. But you soon find out Raiden isn't as resilient as he seems, because as soon as he enters the helicopter he starts to cough up loads of white blood.
Later, Big Mama (a main character) shows Snake a character they've been protecting, as he's considered a biological key to them and Liquid Ocelot. The character is a half living corpse, who is kept this way by life support, and is quite grotesque looking; with the upper layer of muscle and underlying bone shwoing on his face and upper chest--I'll now refer to this body as "the key."
As Snake, Big Mama and her men are trying to escape Liquid's army with the "the key," Liquid's army shoots the van containing "the key" and the motorcycle Snake and Big Mama are riding on beside it, with explosive effect. The van crashes into a building and Snake and Big Mama are violently thrown off the bike. As Snake checks on Big Mama to see if she's alright, he finds that she's landed on a spike protruding from a fence, piercing her through her left side. She then slowly pulls herself from it, resulting in pained sounds, squishing noises, and blood fromt the site of the wound. Big Mama then tells Snake the van that was destroyed was a decoy, and that the real one is actually floating downriver to the canals. When they arrive at the van's location, they find Liquid already there. Snake engages in combat with Liquid, only to lose heavily, as Liquid takes Snake's own knife and stabs him in the shoulder, and proceeds to beat him several times in multiple parts of his body. To finish Snake off, he uses the still imbedded knife to electrocute Snake (as it's a stun knife).
As Liquid escapes by boat with "the key," Meryl, The Rat Patrol, Snake, Big Mama, and Meryl's army surround Liquid with multiple boats, helicopters and spotlights. As they are about to open fire on Liquid, he uses his new system to disable their guns and helicopters, causing the helicopters to lose power and crash in fiery explosions. Liquid then has his men fire on Meryl's army, killing several of them, and for the third total time, disables their nano machines. Now that the soliders are completely helpless, he has his men fire on every soldier in sight, now killing the majority of them (with apropriate blood effects). Liquid then pulls his boat over to the one Snake and Big Mama are currently on, and fires on it with a mounted gun, causing part of their boat to set on fire. Liquid then throws what's left of "the key" onto Snake and Big Mama's currently burning boat. "The key" lands in the fire and starts to burn (which you gradually see in detail). Seeing this, Big Mama crawls into the flames and tries to save it, but gets caught and also starts to burn. Snake then jumps to her rescue and throws her to safety, severly burning the left side of his face in the process.
Later, as Snake and Raiden are escaping a facility, the exit collapses as Raiden passes under, resulting in tons of rock falling onto his body. And while Snake is about to get crushed by a tanker (long story), Raiden--who's still pinned by debris--dislocates his shoulder to reach his sword, and then uses it to sever his arm from his shoulder, with you seeing the arm fly off and the white blood spurt/spray--all while he screams in pain and slowly crawls out.
A brief scene near the end shows Snake who's been exposed to heavy doses of microwave radiation. As a result, you see him throw up heavily on the floor.

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Crude humor:

You can sneak up on enemies, disarm, and then search them for supplies. At one point in the search as you pat them down, you pat their crotch, and have the option to squeeze it hard enough for them to be rendered unconscious.
Snake's gun launderer, Drebin, likes soda, and after drinking it, he's seen burping/belching several times throughout the game.
An early scene shows a soldier come across a rusty, old metal barrel. As he approaches it, he hears a man moaning and digestive noises coming from the barrel. You continue to hear the digestive/flatulent noises as the soldier gets closer. When the soldier flips the barrel, it reveals another masked soldier (main character named Johnny) squatting on the floor with his pants half down, revealing part of his bare behind. As the Johnny and the soldier stare at each other, Johnny passes gas and the soldier smelling it, holds his nose in disgust. Johnny then starts to run with his pants half down as the soldier chases him.
During an early fight with the main villains' private soldiers, Johnny tells his team he really needs to go to the bathroom. As there isn't one, you see and hear as he goes in his pants. Later, while he's disarming a set of lasers for Snake and the team, you see his stained pants, with flies buzzing around the spot--Snake and the team react in disgust and hold their noses.
In one area you come upon an enemy soldier from behind, who's currently urinating in a river. Later on, while you're following a man on a reconnaissance mission, he at one point runs to a bush and starts to urinate, while saying, "Whew! I though I was going to explode!" In both instances you also hear the sound, and in the first encounter, see the stream.

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Strong language: There are 12 uses of d*mn, 9 uses of hell, 7 uses of a**, 2 uses of bastard, 12 uses of sh*t, 1 use of the f-word, and 4 uses of God. Other than the main script, allied soldiers will say things like "You saved my a**!," (rarely) "Sh*t!," and they'll use d*mn and hell lightly throughout the areas they're present.

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Suggestive themes:

Early on, you come across a ruined square, with two naked, male statues on a pedestal. One is crouched, with his (undetailed) genitals and behind showing, and the other is standing, with the same exposed. You have the option to disguise yourself as one of these statues (your suit blends in with the statues' texture, helping you hide from enemies), by posing as one and covering the standing statues genitals--if you do this too much, they'll break off.
There are Playboy magazines available as weapons—if placed on the floor, enemies will be distracted. And you can look through about a dozen pages that show real Playboy models. However, unlike the real magazine, the models are dressed in somewhat skimpy bikinis, not naked.
The B&B (Beauty and the Beast) are a group of four beautiful but deranged women in large bulky suits (which give them specific powers), who constitute the bulk of what are the boss battles, and the base objective for each battle is to strip them of their power suit first, and then finish them off once they're exposed. Their bodies and faces are all based on real-world models, with noticeable breast physics in play. And while you fight, they slowly walk towards you--while the camera focus on their behinds, chest and skintight jumpsuits, leaving very little to the imagination—and if you let them, they will hug or straddle you (sexually), sucking your health in the process.
Naomi (a main female character) wears a science robe and a black button-up shirt underneath. But there's no bra and her black button-up buttons unfastened about half way down—showing a moderate amount of cleavage.
While Snake and the team are on their way to the next objective on their cargo plane, Naomi starts to flirt heavily with Otacon. It escalates until she asks him to show her the way to the helicopter bay, so she can have some privacy while she gets ready to sleep. He shows her, and when he's about to leave, she pulls him in, and it's suggested they sleep together—nothing is shown or heard.
Big Mama (a main character) wears a full jumpsuit and has it zipped down half way, revealing lots of cleavage—it's offset by the fact that she's over 60.
During a mission briefing, an attractive female character walks by Johnny while he's sitting in a chair. He starts to look at her behind and is apparently mesmerized, as he then goes to touch it—Meryl stops him before he can.

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Violence: The overall story is about war and information control, with the effects and consequences of these issues in a modern society. The story also has many strange and bizarre elements; from a main character's hairless pet monkey in a speedo, to a character that can't die, and another character that is supposedly possessed by the main character's twin brother. Add all this, and a load of complicated politics and theology, and you have Metal Gear Solid.

Snake can kill with dozens of weapons, from pistols to rocket launchers, and many of these are customizable. Snake is also equipped with a knife, which, if used, will have him stab or cut the enemy's throat. However, other than the last boss, you don't have to kill in the game (although a few specific areas make it hard not to kill). You can use a non-lethal dart gun, or sneak up on enemies and choke or knock them out until they go unconscious. In fact, the game promotes you not to kill as much as possible, but to instead sneak past or incapacitate your enemies in non-lethal ways.

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Specific scenes of violence:

An early scene has Snake come across Johnny, Meryl (main female character from MGS1) and her team, the Rat Patrol. After they talk for a while an alarm goes off, telling them that Liquid's private army, the FROGS, a group of fully armored and helmeted half female/machine soldiers, are enroute to their position. You then have to fight your way from the top of the building to the basement, by killing (or tranquilizing—it's harder) dozens of the FROG soldiers. When they reach the basement, three FROG soldiers ambush them, and shoot one of the members of the patrol in the shoulder. The Rat Patrol responds by shooting all three simultaneously, and the one who was shot in the shoulder finishes his offender off by shooting it several times while it's down.
Later, Liquid Ocelot test a new technique on his soldiers, Snake and the Rat Patrol. Because of this technique, soldiers start to drop their guns and grip their heads, while screaming in painful tones. Some foam at the mouth, others lose bowl control, and some die from the strain. Many of the soldiers continue to writhe on the floor uncontrollably, and others turn on each other in a wild and confused state and start to beat one another with their fists and guns. Snake and the Rat Patrol are affected similarly, and this is because they all have nano machines that regulate everything in their body, including emotion. So, when Liquid Ocelot turns these off, all of the soldiers' backed-up emotions of fear, panic, guilt, (etc.) are thrust back onto them in an unregulated form.
The B&B (Beauty and the Beast) were once normal women until war changed their life—which caused them to lose their minds. They were soon found by the enemy and made into what they are: beasts. Liquid Ocelot has them search for Snake throughout the entire game, and once you defeat them, Drebin (a main character) tells you each one's graphically tragic and disturbing story. And although, the stories are sickening and quite graphic, you actually don't see anything on screen; Drebin just tells you in text and voice—I'll list them below.
The first boss (one of the four B&B) is named Laughing Octopus, and after you defeat her, Drebin calls in and tells you her story. She's was from a little fishing village, and for unknown reasons, a strange cult hated her village and its people. One night, this cult enters her village while the inhabitants are asleep, and proceed to slowly execute them one by one, except for her. Instead, they make her torture and kill her friends, all the while forcing her to laugh hysterically—this is how she lost her mind and came to be Laughing Octopus.
The second boss is a B&B named Raging Raven, and after you've defeated her, Drebin calls in and tells you her story. As a child, she was captured by enemy soldiers along with countless other children. The soldiers kept them locked up in cramped cages like animals, and gave them very little food, all the while beating them day after day. But one day the soldiers left them to be eaten alive by wild birds. The birds ate the remaining children alive one by one...until they came to her. She turned the tables and ripped them to pieces, escaped her cage, tracked down the soldiers, and in a mindless rage, killed them and their prisoners. This is how she lost her mind and came to be Raging Raven.
The third boss is a B&B called Crying Wolf, and after you've defeated her, Drebin calls and tells you her story. Rebel soldiers killed her family, but she and her younger brother escaped. On their search for safety, they soon come across a group of enemy soldiers, and before being dectected, she takes her brother to a nearby shack to hide. Her brother starts to cry, and in a panic—knowing the soldiers will hear him—she covers his mouth tightly until they pass. When she removes her hand, she finds him to be dead from suffocation. She continues her journey, all the while carrying the dead body of her little brother. When she finally reaches a refugee camp, her brother's body is decomposed, and she's already gone mad. In her madness, hearing the cries and screams of children in the camp (reminding her of him), she kills them, until their cries are silenced. This is how she lost her mind and came to be Crying Wolf.
The fourth boss and leader of the B&B is named Screaming Mantis, and after you've defeated her, Drebin calls and tells you her story. Her family was killed by enemy soldiers, but she escaped and managed to hide in a basement of an abandoned house. But, seeing it was full of dead bodies—she realised she had inadvertantly hid in the basement of a makeshift torture house. Weeks passed as she survived by eating the bodies and drinking the filthy water pooled on the floor, all the while waiting for the upstairs residents to abandon the house. This is how she lost her mind, and became Screaming Mantis.
A later boss battle is set up like a boxing match, but without rules or gloves. To defeat the boss, you pretty much have to beat him to death in a variety of ways with your fists and legs. This battle consists of extremely brutal combat, where both you and the boss use moves like choking each other to death, bashing each other in the head and smashing each other with anything you can find. This goes on for at least ten minutes and is very intense and violent.

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Use of alcohol & tobacco: (The ESRB didn't mention this in their rating) Although there isn't much alcohol use, there is plenty tobacco use. Snake is seen smoking his cigarette constantly. Including in the load screens between chapters, with the smoke effects being quite realistic and convincing. However, the other main characters are always telling Snake he should quit, as it's seen as a negative habit in the series. Cigarettes are also selectable in the inventory, and if you equip them, they'll result in lowering Snake's stress meter, but they also sap his health meter.

Drebin's hairless pet monkey steals Snake's cigarette and starts to smoke it. When Drebin sees the cigarette he tells the monkey, "I don't think so!" and gestures him to throw it down. The monkey complies, as Snake picks up the discarded cigarette for later use. But, near the end of the game, Snake gives the cigarette to the Drebin's hairless monkey, and this time Drebin concedes.
Near the very end, Drebin is seen drinking. He explains to Otacon that he didn't drink before, because the nano machines in his body would break down the alcohol before he could get drunk (guess it's not the taste). He eventually starts to slur his speech and sway his steps; you the other main characters in the background, drinking/pouring champain to celebrate a recent victory; and Drebin's monkey is seen drinking champaign and smoking a cigarette.

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