Entertainment Software Rating Board
Some critics come to believe that the ESRB only rates games AO if they have sex in them, regardless of how explicit the language, violence or even blood is. This also lead them to think the ESRB is not doing its job. Twenty-three games have received and kept adult ratings, but apparently twenty (almost all) games were given it for sexual themes and content. Two had violence, and the other one was given the "Adult" rating for real gambling.