For me it makes a huge difference how all the violence is presented.

Some years ago I was given a Wii game: Onechanbara
Bikini Zombie Slayers... blood fountains... rotten body parts... pretty violent in fact - but: this game was totally through the roof. Everything was so overdone, that it simply can't be taken serious - and you'll simply laugh when some fat Zomb explodes and covers your whole viewport with red blood.
The game itself was mediocre, but it was fun to play - because the violence happening on screen was not realistic.

High realism and special focus on sadism and torture, that's simply no fun, nothing I want to play. That's just disgusting.