It is no surprise that Metal Gear Solid V received an M rating from the ESRB. However, it is a surprise that the game received a ‘sexual violence’ rating which has only been received by one other game in the history of the ESRB. The first was Animamundi: Dark Alchemist, a visual novel released for the PC back in 2006. When asked specifically about the infraction the ESRB commented that there was no visualization of sexual assault, instead it was implied with sound effects. It seems the game is causing waves even before it is released.