KANSAS CITY -- Simone Biles acknowledges the ever-present scars that the Larry Nassar sexual abuse scandal has left on her and the sport of gymnastics.

"It's not easy coming back to the sport, coming back to the organization that has failed you," Biles said during an emotional interview Wednesday as she begins her pursuit of a sixth U.S. Gymnastics Championships title this week. "But, you know, at this point, I try to think I'm here as a professional athlete with my club team. It's not easy being out here, because I feel like every day is a reminder of what I went through, what I've been through, and what I'm going through, and how I've come out of it."

Nassar, the former USA Gymnastics and Michigan State doctor, was sentenced to 175 years in prison in 2018 for sexually abusing more than 200 women and girls over two decades.

Biles, a four-time Olympic gold medalist and a four-time world champion in all-around, expressed the frustration and distrust that she and other survivors feel, and how difficult it's been to process those emotions.

"There's no manual," Biles said. "I feel like as a gymnast, if we're hurt or if something goes wrong, you go to the doctor or your coaches, and they tell you all the right steps to the healing process. But for this, everybody's healing process is different.

"And I think that's the hardest part, because I feel like maybe I should be healed. ... But I feel like it will be an open wound for a really long time, and it might not ever get closed or healed. But it's what I go to therapy for."

Biles said she still tries to take joy in the sport, and that she still wants to compete. But she came to tears talking about the anger she and other survivors feel toward those with USA Gymnastics whom they thought they could trust, but no longer do.

"It's really sad for us, because it becomes a problem whenever we work with future people," Biles said. "How can we trust them? They bring in new people all the time, and I automatically put my foot up because the people that I had known for years had failed us. So it's hard for them to bring anyone up to us.

"It's really hard to talk about. I just feel like ... I don't mean to cry, but it's just ... it's hard coming here for an organization and having had them fail us so many times. And we have won gold. We've done everything they asked [of] us, even when we didn't want to. And they couldn't do one damn job. You had one job. You literally had one job, and you couldn't protect us."

Biles said her apprehension carries over into receiving any kind of medical treatment.

"But my body hurts; I'm 22," said Biles, who has been a world-class gymnast for many years. "At the end of the day ... I have to go do therapy. It will take some time. I'm strong, I'll get through it, but it's hard."

USA Gymnastics later put out a statement, saying it has made improvement but acknowledging it still has work to do.

"We at USA Gymnastics have made a lot of progress in strengthening our athlete safety measures and putting our athletes first, but we know we have more to do," president and CEO Li Li Leung said. "One of our goals is for our athletes to feel comfortable in speaking up and sharing their opinions, and we are listening to what they have to say. We will continue to work hard to demonstrate to Simone and all of our athletes, members, community and fans that we are working to foster a safe, positive and encouraging environment where athlete voices are heard. We join the rest of her fans and the sport in wishing her the best of success this week at the championships."

This is Biles' second competition in recent weeks; she won the GK U.S. Classic all-around title in Louisville last month. Here at the U.S. championships, she'll compete on Friday and Sunday; the men compete Thursday and Saturday. Then the world championships are in October in Stuttgart, Germany. And, of course, the Tokyo Olympics are next year.

Biles took 2017 off after her quadruple-gold Olympic success in Rio de Janeiro. In January 2018, she confirmed via Twitter that Nassar had assaulted her. She said a return to training after that was difficult.

"It was hard to go back into the gym, and you feel everything at once," Biles said. "It hits you like a train wreck. A lot of the days, I would actually walk out of the gym and [coaches] would understand. And then there were times when I just wouldn't show up to the gym, but you get back into a routine. I would be having fun, but it's the little thoughts that creep in. But I've gone to therapy, obviously, so that has helped."

Asked if she could have full faith in USA Gymnastics again, Biles said she wasn't sure.

"All we can do at this point is have faith that they'll have our backs and they'll do the right thing," Biles said. "But at the end of the day, it's just a ticking time bomb. But, we'll see. It's a waiting game.

"I try to focus on my job and us as the athletes out here. I know it's hard for a lot of these girls because they don't understand what's happening because they were a little bit younger. But for me to be here, it's just hard. I try not to think about it.

"I feel like I would focus on it a little more if I was on the outside like Aly [Raisman] and some of the other girls. But since I'm still on the inside, it just breaks my heart to read it or to see it. So I try to focus on my job, do what I'm supposed to. Come out and compete, do what I love."

Still, Biles said she was willing to talk about all this, despite how painful it was.

"I think it's important because we have a platform," Biles said. "I do want to be a voice."