List of AO-rated video games

The Entertainment Software Rating Board (ESRB), the content rating board for games released in North America, has issued an "Adults Only" (AO) rating for 23 released video games. AO is the highest rating in the ESRB system, and indicates that the organization believes that the game's content is suitable only for players aged 18 years and over. The majority of AO-rated games are adult video games, typically those with pornographic or strong sexual content. Three games have been given the rating solely due to extreme levels of violence: the canceled Thrill Kill (1998), the initial cut of Manhunt 2 (2007), and Hatred (2015). The only game to receive the rating for reasons other than pornographic content or extreme violence is Peak Entertainment Casinos (2003), which allows players to gamble using real money. Grand Theft Auto: San Andreas (2004) was temporarily re-rated from M ("Mature") to AO after a sexually-explicit minigame was found hidden in the game, but the M rating was reinstated after Rockstar Games patched out the content. Fahrenheit edited out an explicit sex scene to meet the M rating. The ESRB lists a "director's cut" of the game on PC as having an AO rating, but it is unknown if this was ever publicly released. Self-imposed restrictions by publishers, distributors, and retailers limit the availability of AO-rated games; thus, the rating has been described by journalists as a "kiss of death" and de facto ban. All three major video game console manufacturers (Nintendo, Microsoft, and Sony) prohibit AO-rated games from being published on their platforms. In May 2015, the video game livestreaming service Twitch updated its content guidelines to include a blanket ban on streaming AO-rated games, citing that a previous policy on games containing overt sexual content or extreme violence (which assessed games on a case-by-case basis) was unclear and confusing to broadcasters. This list contains only games that officially released and received an AO rating by the ESRB, and does not include unrated games with adult content which is common with Indie games that are distributed online on platforms such as Steam.