a teen girl is questioned by a mysterious man at the mall. when she tries to walk to the bathroom to get away from him, he follows her briefly. she is visibly upset and asks if he's following her. he says he'll wait for her outside. she goes into the bathroom and breaks out through a window to avoid him. the same character also encounters multiple other characters throughout the game who want something from her, including the guy at the mall again. their intentions aren't always clear and she goes through efforts to avoid them.
if you kill the dog enemies or any of the other creatures in the game, though the dogs are the only ones that resemble real animals. there is a sequence where you have to bludgeon horses on a merry-go-round and they appear to be alive and twitching and make shrieking sounds when you hit them.
the merry-go-round boss fight where you have to bludgeon horses that appear to be real horses may be frightening to some. you might also have to kill dog zombies.
there's a boss that's just a gigantic worm creature but it is more phallic and worm-like than snake-like. in one part, you can be grabbed by a sewer creature's tentacle that might look like a snake dragging someone into the water. this sequence is avoidable.
many of the enemies in the game are intentionally phallic in nature and play off of the main character's fears around womanhood and pregnancy, but nobody is outright ever assaulted by another person. just attacked by creatures.
The main character Heather, a 17 year old girl, wears a short skirt, but great lengths are taken to never show any upskirt shots. One unlockable joke weapon is called the Sexy Beam, which is just her shooting lasers out of her eyes
In the underground subway area, there is an newspaper that can be read not far from the tracks. Once it is read your character is pushed onto the rails. It is implied to be a ghost because you do not ever see it and the paper mentions a dead person.
There are a few levels with claustrophobic level design: tight corners, narrow corridors, etc. There's also the opposite: wide open areas that feel like liminal spaces.
The main character is stalked by several characters and there's a specific section of the game where she will constantly receive notes from one of said stalkers. There is also a first person cutscene where an unknown character watches Heather and proceeds to push her atop the train tracks.
Technically? SPOILERS
The protagonist is set to give birth to God, but she does a sort of spiritual abortion to kill it. But it comes out "half alive" rather than at full ability
While Heather isn’t technically pregnant, there’s a “god” fetus creature that’s been lying dormant in her body since birth and a cult is determined to force her to “give birth” it.
I haven’t played the game but the overarching plot is an allegory for the horrors of teen pregnancy and Heather conquering her fear of it by expelling the demon from her body at the end.
in a nightmare sequence, it's implied a character was hit by or run off the tracks of a rollercoaster by an oncoming rollercoaster car, but the impact isn't shown and the character wakes up from the dream right after.