WATCH & READ: Judge Rosemarie Aquilina's full sentencing of Larry Nassar

After an extraordinary seven days where more than 160 women came forward and told the world what Larry Nassar did to them under the guise of medical practice, the judge who presided over the court had her say in the sentencing of the disgraced Olympic and Michigan State doctor.

Nassar was sentenced by Judge Rosemarie Aquilina to 40 to 175 in prison as she proudly stated "I just signed your death warrant".

Judge Aquilina sentenced Nassar Wednesday morning but had her time to tell the disgraced doctor what she thought of his actions. She started by reading a letter that Nassar wrote last week. Despite requests for it to be released, she chose not to do so out of fear it would re-victimize the survivors of Nassar.

Instead, she read from the letter that she considered in regards to sentencing as an extension of his apology - and because she wasn't sure if she believed it or not.

"The federal judge went ballistic at sentencing since I pled guilty to the state cases and spent 10% on the federal case and 90% on state cases and civil suits. She gave me 60 years instead of 5 to 20 yrs (three consecutive 20 year sentences). I pleaded guilty to possession of (child) porn. From September 2004 to December 2004, four months. Prosecutor even admitted that I never belonged to any porn sites, any chatrooms, was not on the dark web and also they could not prove I viewed it. It was all diluted of course. I shared my electronics and I could not prove that. So for 4 months of porn possession from 2004, I was sentenced to 60 years. Not proper, appropriate."

Nassar also wrote that what he did in the state (sex abuse) cases was medical and not sexual in nature. He said he entered his guilty plea because he lost support after being convicted of porn possession and that he did so to avoid stress on the community, his family, and victims.

The letter continued, punctuated by laughs of disbelief from the audience.

"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, and referred family and friends to see me. The media convinced them everything I did was wrong and bad. They feel I broke their trust. Hell hath no fury like a woman scorned. It is just a complete nightmare - the stories that are being fabricated to sensationalize this. Then the AG would only accept my plea if I said what I did was not medical and was for my own pleasure. They forced me to say that or they were going to trial and not accepting the plea. I wanted to plead no contest. But the AG refused that. I was so manipulated by the AG and now Aquilina and all I wanted was to minimize stress to everyone, like I wrote earlier."

She read one final segment.

"In addition with federal case, my medical treatments with the Olympic/national team gymnastics were discussed as part of the plea. The FBI investigated them in 2015 and found nothing substantial because it was 'medical,' now they're seeking the media attention and financial reward."

With that, Aquilina tossed the letter aside and turned her attention directly to Nassar and asked if he wanted to withdraw his plea. He said he did not want to withdraw it.

Aquilina told Nassar she didn't know anything about him before the case and doesn't even watch sports. As the date of the trial approached, she said she believed there may have been a defense for two reasons: it's her job to be fair and impartial and her father and two brothers are doctors. She said there could have been a medical defense but what Nassar did was not medical treatment in any manner.

With everyone ready for trial, Nassar was ready to plea because there was no medical treatment, she said. 

"You did this for your pleasure and your control. This letter, which comes 2 months after your plea, tells me that you have not yet owned what you did. You still think somehow that you are right, that you're a doctor, that you're entitled, that you don't have to listen, and that you did treatment! I wouldn't send my dogs to you, sir. There's no treatment here. You finally told the truth," she said.

Aquilina encouraged law enforcement to continue investigating.

"There has to be a massive investigation as to why there was inaction, why there was silence.Jjustice requires more than what I can do on this bench," she said.

Aquilina applauded the attorney general's office and the defense council, saying they all did fine work and they made her proud of the legal system.

Then she turned back to Nassar and explained why he had to sit and listen to 168 women explain what he did to them and how it impacted their lives. She cited a 2009 case that says plainly that the law doesn't limit the victim's impact statements and said she didn't find anything that limited the number of victims from coming forward.

"That was part of the plea you entered, to allow the victim impact statements. After that discussion, I know your lawyers, as good as they are, sat down with you and said 'the judge is going to allow this'. When it came down to it, I know it also because this (plea deal) was signed by the attorney general, defendant, and defendant's counsel on November 22, 2017," she said.

Beyond the letter, she said she still doesn't understand why Nassar knew he was wrong. Below is her exact words that she delivered to Nassar:

"Sir, you knew you had a problem. That is clear to me. You knew you had a problem from a very young age, even before you were a doctor. You could've taken yourself away from temptation, and you did not. Worse yet, there isn't a survivor who hasn't come in here and said how world-renowned you were. I trust what they say. You could've gone anywhere in the world to be treated. You could've gone to any resort, any doctor, place, where you could get treatment. In Europe, they have all sorts of hidden places for things like this. No one had to know and you could have found some treatment, some help and you could have taken some medicine. You would have done that if you had cancer. I knew you would've. You're about self preservation. But you decided to not address what's inside you that causes this control or urge, that causes you to be a sexual predator. 

"So your urges escalated and based on the numbers that we all know, go unreported, I can't even guess how many vulnerable children and families you assaulted. Your decision to assault was precise, calculated, manipulative, devious, despicable. I don't have to add words because your survivors have said all of that and I don't want to repeat it. 

"You can't give them back their innocence, their youth. You can't give a father back his life, or one of your victims, her life, when she took it. You can't return the daughter to the mother; the father to the daughter. You played on everyone's vulnerability. I'm not vulnerable. Not to you. Not to other criminals at that podium. I swore to uphold Constitution and the law and I am well trained. I know exactly what to do. At this time i'm going to do it. 

"I want you to know that as much as it was an honor and privilege to hear sister survivors, it is my honor and privilege to sentence you because sir, you do not deserve to walk outside of a prison ever again.

"You have done nothing to control those urges, and anywhere you walk, destruction will occur to those most vulnerable.

"I have honored the agreement. I'm also honoring what's been requested of me. I want you to know I'm not good at math. I have a cheat sheet. I'm only a lawyer, I know that you had a lot of education in physics and math, but i have a cheat sheet. It is my privilege on counts 1, 2, 5, 8, 10, 18, and 24 to sentence you to 40 years.

"I'm going to look at my cheat sheet - 40 years just so you know and you can count it off your calender, is 480 months. The tail end, because I need to send a message to the parole that somehow God is gracious - and I know he is -  and you survive the 60 yrs in Federal Court first, and then you start on my 40 years, you've gone off the page here as to what I'm doing. My page only goes to 100 years. Sir, I'm giving you 175 years, which is 2,100 months. 

"I just signed your death warrant."

"I find that you don't get it - that you're a danger, you remain a danger. I'm a judge that believes in life and rehabilitation and that rehabilitation is possible. I've had defendants come back here and show me great things they've done with their lives after probation, after parole. I don't find that possible with you."

With that, the judge gave him credit for 369 days served in jail. 

If Nassar is ever released, which she said was doubtful, he is required to register as a sex offender. He will also have to pay restitution to his victims but that number has not yet been determined. It will be done by victims who submit for restitution so Judge Aquilina can determine a reasonable amount. 

Aquilina recommended Nassar for mental health treatment in prison.

Nassar has 21 days to appeal the sentencing.

Aquilina addressed the media and said she would not make statements regarding the case. 

"It's just not my story. After the appellate hearing runs, with victims by my side, to tell their stories, beyond answers to your questions and what I've said on the record, I don't know what more I could possibly say. I'm not going to talk with any media person until after the appeal hearing. Even then, if you talk to me about this case, I will have a survivor with me because it is their story."

She said she respects the media and thanks them for being in attendance because it's important for the survivors.

With that, Judge Aquilina said she and Nassar would both leave the court and she would turn the room over to victims and survivors so they could have a press conference in the courtroom.

"Sir, I hope, somewhere you have heard everybody's words and it does resonate with you."

With nothing else to add by Aquilina or attorneys, she left the court to a round of applause from the gallery.