WARNING: Graphic content

AFTER hearing from an astonishing 156 accusers, former US Olympic gymnastics doctor Larry Nassar has been sentenced to between 40 and 175 years in prison for molesting girls and women who went to him for treatment.

Judge Rosemarie Aquilina sentenced Nassar this morning.

“I just signed your death warrant,” she said. “It is my honour and privilege to sentence you. You do not deserve to walk outside a prison ever again. You have done nothing to control those urges and anywhere you walk, destruction will occur to those most vulnerable.”

He had pleaded guilty to sexually assaulting seven females in the Lansing area between 1998 and 2015, but the hearing was open to all of his accusers.

His accusers said he would molest them while they were on a table seeking help for various injuries.

When the hearing ended, the courtroom broke into applause. Victims and prosecutors embraced at the conclusion of the gruelling 16-month case. It was the second long-term prison sentence for the 54-year-old physician. He has also been sentenced to 60 years in federal prison for child pornography crimes.

Nassar has told his sexual assault victims that “no words” can describe how sorry he is for his crimes.

Nassar turned to the courtroom gallery to make a brief statement before his sentence.

He says the testimony of more than 150 victims since last week has “shaken me to my core.”

“I will carry your words with me for the rest of my days,” he said as many of his accusers openly wept.

But Judge Aquilina said his words were hollow and read from a letter he had submitted to the court just last week to prove her point.

“What I did in the state cases was medical, not sexual, but because of the [federal porn conviction] I lost all credibility,” he wrote. “So I’m trying to avoid a trial to save the stress to my community, my family. But look what’s happening. It’s wrong.”

“I was a good doctor, because my treatments worked and those patients that are now speaking out were the same ones that praised and came back over and over,” wrote Nassar. “The media convinced them that it was wrong and bad. Hell hath no fury like a woman scorned.”

“Now [the victims] are seeking the media attention and financial reward,” he wrote.

Judge Aquilina said she did not accept his apology as genuine.

“This letter tells me you have still not owned what it is that you did. That you still think you’re right, a doctor,” she told him. “I wouldn’t send my dogs to you, sir.”

Prosecutor Angela Povilaitis said she hoped there would be a shift in society so victims didn’t have to suffer in silence and fear.

“It takes some kind of sick perversion to not only assault a child but to do so with her parent in the room,” she said. “To do so while a line-up of eager young gymnasts waited.”

She described the “breadth and ripple” of Nassar’s sexual abuse as “nearly infinite.”

“What does it say about our society that victims of sexual abuse have to hide their pain for years when they did nothing wrong? What does it say about our society when victims do come forward ... and are treated as liars until proven true?” Ms Povilaitis said.

One of the first athletes to publicly accuse Nassar of sexual assault was the last victim to offer a statement at the hearing.

Rachael Denhollander is a Kentucky lawyer who stepped forward in 2016 after the sport’s governing body was accused of mishandling complaints of sexual assault.

She said Nassar groped, fondled and penetrated her with his hands when she was a 15-year-old gymnast in Michigan.

Denhollander’s statements to Michigan State University police put the criminal investigation in high gear in 2016.

“You have become a man ruled by selfish and perverted desires,” she told Nassar. “The sentence rendered today will send a message across this country. And so I ask, how much is a little girl worth? How much is a young women worth?’

After the sentencing, the United States Olympic Committee said it will hold an independent investigation into the sex abuse scandal which has rocked USA gymnastics.

In an open letter, USOC chief executive Scott Blackmun said the probe would seek to establish “who knew what and when.”

“The USOC has decided to launch an investigation by an independent third party to examine how an abuse of this proportion could have gone undetected for so long,” Mr Blackmun wrote.