UPDATE: On March 23, an additional 19 women came forward with a notice of intent to file a legal claim against former USA Gymnastics physician Larry Nassar for sexual abuse, according to a report from Michigan Live. As of March 16, the total number of women suing the physician was 78. Now, court documents list 84 former patients of Nassar as plaintiffs in multiple lawsuits. With these additional 19 women adding their names to the lawsuit on Thursday, the total number of women suing Nassar is now at 103. Head over to Michigan Live to read more.

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Today, 20 women and girls were added to a lawsuit against former USA Gymnastics and Michigan State University doctor Larry Nassar, bringing the total number of women suing the physician to 78. Eighty-one women and girls have come forward with allegations of abuse against Nassar since two gymnasts publicly accused him of sexual abuse in September.

As of Thursday afternoon, 78 of the 81 alleged victims are suing Nassar, MSU and USA Gymnastics in six separate lawsuits spanning both federal and state courts. The lawsuits allege that Nassar sexually abused the young women during medical appointments, dating as far back as 1997. According to the Detroit Free Press, Nassar assaulted girls as young as 12 on MSU’s campus, a gymnastics club in Dimondale, MI, as well as places he traveled during his time with USA Gymnastics.

USA Gymnastics president Steve Penny resigned on Thursday afternoon in the wake of the allegations. “It has been heartbreaking to learn of instances of abuse and it sickens me that young athletes would be exploited in such a manner,” Penny wrote in a statement announcing his resignation.

Police Handout Dr. Larry Nassar's mugshot.

Most of the women who have come forward against Nassar are athletes or former athletes, many of whom were top-tier gymnasts. In a September interview with the Indianapolis Star, the first two women to publicly accuse Nassar alleged that when they were minors, the physician fondled and penetrated them with his fingers ― all under the guise of medical care. Both said Nassar penetrated them vaginally and anally without gloves or lubricant.

“I was very confused, trying to reconcile what was happening with the person he was supposed to be,” former gymnast Rachael Denhollander told IndyStar in September. “He’s this famous doctor. He’s trusted by my friends. He’s trusted by these other gymnasts. How could he reach this position in the medical profession, how could he reach this kind of prominence and stature if this is who he is?”

I was very confused, trying to reconcile what was happening with the person he was supposed to be. Rachel Denhollander, Former Gymnast

Nassar, a 53-year-old Michigan-native, was a highly-renowned doctor in the gymnastics world for years. He worked as the USA Gymnastics’ team doctor during four Olympic games and was a faculty member at Michigan State’s College of Osteopathic Medicine. In September 2015, Nassar quietly resigned from his position on the USA Gymnastics team, and in 2016 was fired from MSU after the allegations went public.

In December, Nassar was arrested on federal child pornography charges and now faces 28 criminal charges between state and federal courts. He pleaded not guilty.

IOPP via Getty Images Nassar was a physician for the USA Women's Gymnastics team during the 1996 Olympics. This is 1996 Women's USA team singing the national anthem after they won gold.

Out of the 78 claims of sexual abuse against Nassar, almost all the victims allege that the physician penetrated them with his fingers while they were minors. More than 20 of the women and girls said there was a parent in the room during the medical exam.

According to court documents filed on Thursday obtained by the Detroit Free Press, one mother asked what Nassar was doing while he was examining her daughter. He “gave an explanation she did not understand” and “did not explain that he was using vaginal or anal penetration,” an attorney wrote. Attorneys also wrote that the same mother stood up in an attempt to see what Nassar was doing to her child and the physician moved to block her view.

Nassar gave gifts to the young athletes, made sexual comments while abusing them and one woman said she suffered “bleeding and soreness” from him penetrating her with his fingers, according to court documents.

In an essay published on Wednesday for The New York Times, former U.S. rhythmic gymnast Jessica Howard claimed she was 15 years old when Nassar began sexually abusing her.

Reuters Photographer / Reuters Jessica Howard, who accused Nassar of sexually abusing her as a minor, competes in the all-around rhythmic gymnastics competition at the 1999 Pan American Games in Manitoba, Canada.

“Coming off of a difficult year of training, Dr. Nassar reached out as the good guy, supporting me emotionally and promising me relief from the pain,” Howard wrote. “Now I know that in actuality he expertly abused me under the guise of ‘treatment.’”

Just last week, five more people ― four with ties to MSU and one Dinondale, MI gymnastics club owner ― were added to one of the civil lawsuits. According to The Detroit News, the lawsuit claims that the five people knew about the alleged abuse and could have stopped it.

After reading the accounts of many of Nassar’s survivors, one theme resonates: They all trusted Nassar; their coaches trusted Nassar; their parents trusted Nassar.

As the first woman to accuse Nassar of abuse, known only as Jane Doe, told IndyStar in September: “It felt like a privilege to be seen by him. I trusted him.”