After four years in court, a first-of-its-kind legal battle over operating on “intersex” babies who are born with ambiguous genitalia has finally settled for $440,000, according to court records made public on Wednesday.

The lawsuit was brought by Pam and Mark Crawford on behalf of their adopted son, M.C., against the Medical University of South Carolina, where M.C.’s genital surgery was performed when he was 16 months old. South Carolina Department of Social Services, which technically had custody of M.C. at the time, and Greenville Hospital System, who referred him to surgeons at MUSC, were also named in the suit. Greenville settled for $20,000 last year. (MUSC will pay $270,000 to a structured settlement company, which will purchase an annuity policy that will pay M.C. a total of $440,000 over the next 16 years.)

The Crawfords alleged that M.C. — who was operated on to look like a girl, but grew up to identify as a boy — has incurred medical bills, pain and suffering, psychological damage, and impairment as a result of the surgery. MUSC “denied all claims of negligence and any liability for the alleged claims but agreed to this compromise of a vigorously disputed claim to avoid the costs of litigation,” according to the settlement.

The case has been closely watched by intersex researchers and advocates, who say it’s the first to openly challenge intersex surgeries on babies. Although some scientists are wary of using the court system to challenge the standard of care in medicine, advocates say it’s become their only option.

”It’s the only lawsuit we’re aware of that’s become public at all,” Bo Laurent, who founded the Intersex Society of North America and testified in M.C.’s case, told BuzzFeed News. “More and more, surgeons are going to realize that they’re at risk of these suits. Nobody can say this was uncontroversial standard practice. It is controversial.” Read more via Buzzfeed