Who comes up with ratings?

[LostInTime]

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Kimberly Peirce, whose Boys Don't Cry  inspired an Oscar-winning performance by Hilary Swank, describes her incredulity at receiving the MPAA board's NC-17 rating, which meant fewer theatre bookings, and practically no newspaper or TV ads to support her pioneering depiction of a young transsexual's ultimately deadly attempt to pass for a boy.

"I said to my lawyer, what were the problems? There were three: after Brandon goes down on Lana, he comes up and he wipes the cum off his mouth. We had a strike on that. 'What's the problem?' 'Well, we don't really know, but that's really offensive.' So I was like, 'I shoot Brandon in the head, and do all these things to him, and that's fundamentally okay? Can somebody explain that?'