List of regionally censored video games in the fictional world

Many video games have certain elements removed or edited due to regional rating standards and cultural differences. While, in the past, games were often toned down when translated overseas, in terms of violence, religious references, profanity, drug use, etc., when compared to their Japanese counterparts, in recent years Computer Entertainment Rating Organization (CERO), among other ratings organizations, have imposed harsher restrictions on violent games.

This is meant only for fictional games. Real games have their own Wikipedia article.

Generation 3 (1983 - 1990)

 * Driller Engine 1 Touhou Project games - Due to the first five Touhou Project games being published by Nintendo internationally, all references to Christianity, Judaism, and Islam were removed. Nintendo allowed Drillimation to keep the references to Buddhism and Shintoism in the localizations due to there not being very many Buddhists and Shintoists that reside in the United States.
 * Lucky Star 3: Dr. Manhole's Curse - All statues depicting "ecchi" were removed and/or covered up.

Generation 4 (1987 - 1995)

 * Super Lucky Star 4 - The game faced a lot of censorship during localization. A drop of blood on the game's title screen was removed, and all other depictions of blood in the game were either removed or had their color changed to green or gray. All crosses on gravestones with the exception of the rosary were removed, and all nude statues were covered up and/or replaced.
 * Touhou 6: The Embodiment of Scarlet Devil - During localization, some of the game's dialogue was tweaked in order to better suit North America and Europe's cultures. All references to Christianity and cannibalism were removed.
 * Driller Engine Grand Prix - The champagne was replaced with a bottle of soda in the endings.
 * Touhou 7: Perfect Cherry Blossom - Two spell cards depicting swastikas in both the Extra and Phantasm stage were censored. These changes likely had to be done in order to greenlight a release in Europe, due to a law in Germany that forbids the use of swastikas and other Hitler-related imagery.
 * Touhou 8: Imperishable Night - While not very many things were censored, one hacker found unused voice clips of characters cursing in the international version of the PC version of the game. They were discovered a year after the game's release, and all future releases of the game had these clips removed in order to keep its rating of E in North America.

Generation 5 (1993 - 2001)

 * Driller Engine Grand Prix 2 - One billboard in the game was replaced in the international version of the game due to it being sponsored by Marlboro. Drillimation worried this could cause controversy with tobacco in a kid-friendly game so it was removed.
 * To Heart - This was one of the most censored games in 1997, as the amount of violence and sexuality was toned down in the international version of the game. Due to large amounts of "ecchi" scenes, these were likely removed and/or toned down so the game can receive a rating of T in North America. All scenes involving nudity was covered up, and six explicitly violent scenes were blocked out and replaced with placeholder images including an explicit description of what happened to mock the changes. The North American version has a face-palming Susumu Takajima over a yellow background, the European version has an angry Remilia Scarlet over a magenta background, and the Australian version has Yumi Ochiai standing glumly on the shore of a beach in the Australian city of Gold Coast.

Generation 6 (1998 - 2009)

 * Touhou 14: Double Dealing Character - All instances of Sekibanki detaching her head were removed. Instead, the localizers redesigned her player model so her neck would extend instead.