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.