Tsukihime, Fate/Stay Night, and Fate/Hollow Ataraxia were originally released as eroge games with hentai scenes in certain story routes. While the sex scenes in Tsukihime have little impact on the plot beyond building character relationships, the Fate games tied it in more by establishing sex as a means to transfer mana between two people. Years before their release, creator and writer Kinoko Nasu revealed frustrations at his previous job before co-founding Type-Moon with illustrator Takashi Takeuchi. He felt his producer's expectation of including obligatory H-scenes had "no understanding on a conceptual level" and resulted in H-scenes with no "passion". While he had no issue writing "normal" H-scenes, he found it difficult to write H-scenes with "a heavy emphasis on its plot" and keep them consistent with it. His solution to these qualms at Type-Moon when working on Tsukihime was to let Takeuchi come up with ideas and dialogue direction for H-scenes, and then fill in the blanks in the story.

This approach carried over to the Fate games, where they took a bolder public stance in their marketing. Around F/HA's release in 2005, Nasu insisted that certain story routes were "based around having porn", while Takeuchi commented that they wanted to use it as a vehicle for freedom of expression by telling a well-written story that could appeal to people beyond the H-scenes. However, starting with the expanded PlayStation 2 version of F/SN in 2007, almost all of the sexual scenes and plot elements in the Fate games (and at different periods Tsukihime) were either removed or rewritten in future releases, remakes, and anime/manga adaptations. Nasu felt the PS2 version of F/SN was the final version at the time due to its other improvements over the original version, and later clarified that he did not have "any objections to the presence or absence of sexual content if it fits the needs of the story". While the original eroge version of Tsukihime has not been re-released in recent years, Type-Moon re-printed the original eroge versions of the Fate games as a bundle in 2014 and 2019.

In a 2001 chatroom interview, the game's lead artist Takashi Takeuchi revealed that Arcueid's character design was based on a foreign model that he first saw in a fashion magazine in 1995 and became infatuated with. Two images of the model were posted during the interview, though her identity was still unknown to him and writer Kinoko Nasu at the time. Eventually in 2024, she was identified by fans through more magazine photos from the mid-1990's as a Canadian model named Amanda Dyer, who confirmed that the images were taken from photoshoots of her as a teenager in Tokyo. In an interview the following year, she described the newfound interest and online interactions with fans as "unexpected, emotional, and honestly, a lot of fun", and began incorporating it into her modelling career. She also shared an unreleased photo from the time period of one of her favorite outfits from the Tokyo photoshoots that she felt was "almost prophetic", where she wore a white turtleneck sweater and a grey skirt while holding a cat. Not only did this outfit have a striking resemblance to Arcueid's outfit in the game, but she would coincidentally be parodied as a catgirl in the game through Neco-Arc.