The "extra quality" aspect could refer to:
The "Entertainment" in Super Game 121b Extra Quality Lifestyle and Entertainment is deliberately broad. This system handles: super deepthroat game 121b extra quality
Try the "No Hands" challenge (keyboard only):
Map keys in controls.txt – The "extra quality" aspect could refer to: The
Goal: reach orgasm without touching the mouse. Surprisingly hard, but teaches the rhythm system deeply. Goal: reach orgasm without touching the mouse