The episode was written by series co-creator Trey Parker and was rated TV-MA LV in the United States, due to language and violence. It was one of the first episodes of South Park to use any of the L, S, or V sub-ratings. Parker and Stone had many discussions with Comedy Central as how to portray the language used in the episode. Eventually, the network allowed them to use nearly all curse words except for "fuck", which remained bleeped. Prior to its premiere, the episode attracted attention from the Tourette Syndrome Association (TSA, renamed in 2015 to the Tourette Association of America), who "fully expect[ed] it to be offensive and insensitive to people with TS".
