That's at the discretion of ESRB, which got egg on it's face with Oblivion so I doubt they are too happy with Bethesda.
The only people who are typcally "offended and alienated" are advlts who either have rather outdated views on such matters or actualy look into the contents of a game before they let their children play.
Which, sad to say, I doubt many parents honestly do. In fact, Im sure most of todays parents buy the game for themselves, and knowing the content, let young kids play them aswell.
I have nothing wrong with kids playing M rated games, I did when I was under-aged. The fact of the matter, just throwing in nudity for nudity's sake is just pathetic and catering to those that have to see nudity all the time. I like sixual content as much as the next guy just not in TES. Leave that for GTA, I was fine with it in there. Also nudity and heavy gore together and used at leisure would most likely merit an AO rating and BGS does not want that.....no game company wants that.