List of AO-rated video games
The Entertainment Software Rating Board (ESRB), the video game content rating board for North America, has issued an "Adults Only" (AO) rating for 27 released video games. AO is the highest rating in the ESRB system, and indicates that the game contains content which the ESRB believes is only suitable for those 18 and older. The majority of AO-rated games are adult video games, those with pornographic or strong sexual content. The rating has also been issued for three games 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 other reasons is "Peak Entertainment Casinos" (2003), which allows players to gamble using real money. "" (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 and distributors limit the availability of AO-rated games, thus the rating has been described as a "kiss of death" by journalists, and is essentially a ban. All three major  video game console manufacturers (Nintendo, Microsoft, and Sony) prohibit AO-rated games from being published on their platforms. Most retailers refuse to stock them, and the popular video game live streaming service Twitch forbids streaming them. 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, 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).