As of this episode, Garrison has changed back into a man. "Mr. Garrison's Fancy New Vagina" was the last time Garrison was seen as a man.

Cartman: All right, lets go get you an abortion.
Maleta: No, I'm Catholic. I think abortion is wrong.
Cartman: Abortion isn't wrong! What's the one thing I've been teaching you?
Maleta: That cheating.. is good?
Cartman: Yes! And abortion is the ultimate form of cheating!

Cartman: Everyone review the section on sports casters forgiving the Patriots for cheating and saying it was no big deal.

Cartman: Abortion is the ultimate form of cheating! You're cheating nature itself! Why do rich white girls get ahead in life? Because they get abortions when they are young. They get pregnant but they still want to go college, so whatever, they just cheat. They cheat that little critter in their belly right out of a chance at life.

Linda: Stephen! Stephen, come quick!
Stephen: What is it, dear?
Linda: A penis is loose in our kitchen!
Stephen: A penis?
Linda: Yes! It just ran across the floor.
Stephen: Now darling, calm down.
Linda: Calm down nothing! I don't want that penis running through my house!
Stephen: (aside to Butters) Oh, women. Always afraid of penises.

Mr. Garrison: But you know, I've learned that I've really been a dude all along. Because the key difference between men and women is that women can have babies. If you can't have babies, then you're a man.
Thompson: Whoa, uh, wait, hang on a second. My wife had ovarian cancer so she can't have babies.
Mr. Garrison: Well then get an AIDS test Thompson, 'cause your wife's a dude, faggot!

The school Cartman teaches at is called Jim Davis High School. But when he plays basketball with one of his students, the scoreboard outside reads East High School.

Stand and Deliver:

Cartman's subplot in this episode is a parody of the film Stand and Deliver (1998). In the movie a Hispanic man named Mr. Escalante, played by Edward James Olmos, teaches a class of troubled students. Much of Cartman's dialogue, "how do I reach these kids," as well as his appearance are in direct reference to the film and characters.

Another reference found during Cartman's subplot was the name of the school he teaches at. In the episode, Cartman teaches at Jim Davis High School. Jim Davis writes the comic Garfield, which happened to be in the name of the high school in Stand and Deliver.

An American Tail:

The scene in which the mouse and penis are singing under the moon is a parody of the film An American Tail (1986), the story of Fievel. During a scene in the original movie, two mouse siblings begin to sign the song "Somewhere Out There."

Thomas Beatie:

At the beginning of the episode, Garrison talks about a pregnant man who appeared on Oprah. That man, Thomas Beatie, was a woman until 1998. Thomas then decided to become a man, but retained the female genitalia parts. After artificial insemination, Thomas became pregnant.

2007 New England Patriots:

Throughout the episode Cartman refers to Bill Belichick, and the Spygate scandal from the 2007 season of the New England Patriots. Coach Belichick was caught videotaping the New York Jets' signals during a game in September, an act that was in violation of league rules. The Patriots then went 16-0 to complete a perfect season, only to lose to the New York Giants in Super Bowl XLII.