I think you're confusing "direct to you" with withdrawing from Itch; they're different things.
Your account and the content of a project are separate entities. You can link a PayPal account to your Itch account and request a withdrawal without any issues. Itch has never blocked withdrawals and has paid several NSFW content creators.
If, for any reason, Itch considers your project to be in violation of its rules and you can't receive the money, Itch will handle refunding the buyers.
What Itch no longer allows is indexing an NSFW project that receives money, and depending on the content, it might not allow you to sell the product. However, you can always withdraw the money you already have in Itch.