# 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 24 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. Four games have been given the rating solely due to extreme levels of violence: the canceled Thrill Kill (1998), the initial cuts of The Punisher (2005), 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.
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.

## Games released with an AO rating

| Release | Title | Platform | Publisher | ESRB content descriptors | Notes |
| 1993 | The Joy of Sex | CD-i | Philips Media | Strong sexual content | Interactive video media containing a game. |
| 1995 | Crystal Fantasy | Mac, Windows | MacDaddy Entertainment | Strong sexual content | |
| 1996 | Cyber Photographer | Mac, Windows | MacDaddy Entertainment | Strong sexual content | |
| 1997 | All Nude Cyber | Mac, Windows | MacDaddy Entertainment | Strong sexual content | |
| 1997 | All Nude Glamour | Mac, Windows | MacDaddy Entertainment | Strong sexual content | |
| 1997 | Riana Rouge | Mac, Windows | Black Dragon | Realistic blood and gore, strong sexual content | |
| 1998 | Erotic Heat Vol. 4: Body Language | DVD | NuTech Digital | Strong sexual content | |
| 2000 | Playboy Screensaver: The Women of Playboy | Mac | Sony Imagesoft | Mature sexual themes | |
| 2000 | Sexy Games | Mobile phone | Nicosceles | Sexual themes, partial nudity | |
| 2000 | Singles | Windows | Eidos Interactive | Nudity, strong sexual content | |
| 2001 | Snow Drop | Windows | Peach Princess | Strong sexual content | |
| 2001 | Tokimeki Check-in! | Windows | Peach Princess | Strong sexual content | |
| 2001 | Water Closet: The Forbidden Chamber | Windows | Peach Princess | Strong sexual content | |
| 2001 | X-Change | Windows | Peach Princess | Strong sexual content | |
| 2002 | Critical Point | Windows | Peach Princess | Strong sexual content, violence | |
| 2003 | Peak Entertainment Casinos | Online, Windows | Peak Entertainment | Gambling | Peak Entertainment, a provider of online gambling services, submitted its product to the ESRB for an AO rating to demonstrate its commitment to discouraging underage gambling. It is the only AO-rated game to receive the rating for reasons unrelated to violence or sexual content. |
| 2004 | Leisure Suit Larry: Magna Cum Laude Uncut and Uncensored | Windows | Vivendi Universal Games | Mature humor, nudity, strong language, strong sexual content, use of alcohol | |
| 2006 | Playboy: The Mansion: Private Party | Windows | Groove Media | Nudity, strong sexual content | Expansion pack for Playboy: The Mansion. |
| 2009 | Manhunt 2 (uncut version) | Windows | Rockstar Games, Take Two Interactive | Blood and gore, intense violence, strong language, strong sexual content, use of drugs | |
| 2013 | Seduce Me | Mac, Windows | No Reply Games | Strong sexual content, nudity, strong language, use of drugs | Developed by a studio led by former Guerrilla Games employees Miriam Bellard and Andrejs Skuja, it was pulled from the Steam Greenlight program for its sexual content. |
| 2014 | Ef: A Fairy Tale of the Two | Windows | MangaGamer | Blood, nudity, sexual violence, strong language, strong sexual content | Unlike other self-rated games by MangaGamer, this game was sent to the ESRB at the request from the Japanese developer in order to get a green-light for a hardcopy release in the United States. |
| 2015 | eden* PLUS+MOSAIC | Windows | MangaGamer | Nudity, strong language, strong sexual content | This game was sent to the ESRB at the request of the Japanese developer in order to get a green-light for the release in the United States. |
| 2015 | Hatred | Windows | Destructive Creations | Blood and gore, intense violence, strong language | The game, along with its Steam Greenlight campaign, had been controversial due to its premise, which focuses on a main character who indiscriminately murders every person he encounters. |

## Games that received, but were not released with an AO rating

In some cases, a game that initially received an AO rating from the ESRB was edited prior to their initial release in order to meet the criteria for an M rating. In selected cases, an AO-rated game was cancelled prior to its release, temporarily received the rating post-release due to the inclusion of normally-inaccessible content that met the rating, the uncut version of the game was released at a later date with an AO rating, or an unrated or self-rated version, patch, or downloadable content (DLC) was released via a platform with more liberal content rules (such as Steam).
| Release | Title | Platform | Publisher | ESRB content descriptors | Notes |
| 1997 | Wet: The Sexy Empire | Windows | CDV Software Entertainment USA | Strong sexual content | Never officially released in North America. |
| 1998 | Thrill Kill | PlayStation | Virgin Interactive | Animated blood and gore, animated violence | The game's release was cancelled after publisher Virgin Interactive's U.S. operations were acquired by Electronic Arts, which objected to the game's subject matter. |
| 2004 | Grand Theft Auto: San Andreas | Windows, PlayStation 2, Xbox | Rockstar Games, Take Two Interactive | Blood and gore, intense violence, nudity, strong language, strong sexual content, use of drugs | Originally rated M, San Andreas was temporarily re-rated AO following the discovery of an incomplete "Hot Coffee" minigame that could be enabled with a mod or cheating device, which featured characters engaging in sexual intercourse. Its rating was changed back to M after Rockstar released a patch that removes the offending content entirely. |
| 2004 | The Punisher | Windows, PlayStation 2, Xbox | THQ | Blood and gore, drug reference, intense violence, strong language | The game was edited prior to release to meet the M rating, including adding a black and white visual effect to the "interrogation" sequences, which typically consist of the player committing various brutal torture methods to an enemy or innocent victim. If an NPC is killed in these scenarios, the camera also usually zooms in on the Punisher's face instead of depicting their death. |
| 2005 | Lula 3D | Windows | CDV Software Entertainment USA | Blood, nudity, strong language, strong sexual content, violence | Never officially released in North America. |
| 2005 | Fahrenheit | Windows, PlayStation 2, Xbox | Atari | Blood, nudity, strong language, strong sexual content, use of drugs and alcohol, violence | Sex scenes were edited out of the game to meet the M rating for its North American release, which was also retitled Indigo Prophecy. Quantic Dream CEO Guillaume de Fondaumière remarked that many players imported the uncut European release instead. 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. A 2015 remaster of the game received an M rating with no cuts. |
| 2007 | Manhunt 2 | PlayStation 2, PlayStation Portable, Wii | Rockstar Games, Take Two Interactive | Blood and gore, intense violence, strong language, strong sexual content, use of drugs | The game was edited prior to release to meet the M rating. In 2009, an uncut version was released for PC under the AO rating. Both cuts were also refused classification in the United Kingdom, but Rockstar successfully appealed for an "18" rating on the M-rated edit. |
| 2017 | Outlast 2 | Windows, PlayStation 4, Xbox One, Nintendo Switch | Red Barrels | Blood and gore, intense violence, nudity, strong language, strong sexual content | The game was edited prior to release to meet the M rating. In 2018, the game's PC version released a patch on Steam that reinstated the cut content. The Australian Classification Board originally refused to give the game a classification, effectively banning it from being released until an edited version was granted an R18+ classification. |
| 2018 | Agony | Windows, PlayStation 4, Xbox One, Nintendo Switch | PlayWay, Forever Entertainment | Blood and gore, intense violence, nudity, strong language, strong sexual content | The game was originally given an AO rating, but was edited in order to meet the M rating. The game's developer Madmind Studio intended to release a patch for the PC version to restore the cut content, but it was blocked by its publisher for "legal reasons". The game was reissued on Steam as the self-published Agony Unrated in October 2018, which is uncensored and contains other patches and improvements. |
| 2018 | Conan Exiles | Windows, PlayStation 4, Xbox One, Xbox Series X/S | Funcom | Blood and gore, intense violence, language, nudity, use of alcohol | The console versions of the game remove the full-frontal nudity present in the Windows version to meet the M rating. |