Super Real Mahjong PV is the fifth installment in the strip mahjong series. There is no background story in the game; the player is merely introduced to three high school girls - Mizuki, Aya, and Akira - who challenge him to the game of mahjong. The main mahjong mode is that of the one-on-one variety; after each successfully completed round the girl removes a part of her clothing.

The computer versions of the game contain scenes with nudity; among the console versions, the PC-FX one is the only one that similarly lacks censorship. Some of the versions have secondary gameplay modes, such as a team mode in which the player controls three girls and plays mahjong against three others.