The problem with America is that it's pretty much 50 different countries. Each State has massively different attitudes to sex. Many states didn't legalise homosexual sexual activity until they were forced to in 2003 and quite a few of those also made it illegal for heterosexuals to engage in non-vaginal sex. It's still illegal to sell sex toys in Alabama.
So when you have an age rating that is to apply to all these massively different places with different laws, it gets a little complicated.
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