The New York Times has identified at least 40 girls and women who say Nassar molested them between July 2015, when he first fell under FBI scrutiny, and September 2016, when he was exposed by an Indianapolis Star investigation.

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For more than a year, an FBI inquiry into allegations that Lawrence G. Nassar, a respected sports doctor, had molested three elite teenage gymnasts followed a plodding pace as it moved back and forth among agents in three cities. The accumulating information included instructional videos of the doctor’s unusual treatment methods, showing his ungloved hands working about the private areas of girls lying facedown on tables.

But as the inquiry moved with little evident urgency, a cost was being paid. The New York Times has identified at least 40 girls and women who say Nassar molested them between July 2015, when he first fell under FBI scrutiny, and September 2016, when he was exposed by an Indianapolis Star investigation. Some are among the youngest of the now-convicted predator’s many accusers — 265, and counting.

The three alleged victims then at the center of the FBI’s inquiry were world-class athletes; two were Olympic gold medalists. Nearly a year passed before agents interviewed two of the young women.

The silence at times drove the victims and their families to distraction, including Gina Nichols, the mother of the gymnast initially known as “Athlete A”: Maggie Nichols, who was not contacted by the FBI for nearly 11 months after the information she provided sparked the federal inquiry.

“I never got a phone call from the police or the FBI” during that time, Gina Nichols, a registered nurse, said. “Not one person. Not one. Not one. Not one.”

The FBI declined to answer detailed questions about the speed and nature of its investigation or to provide an official who might put the case in context. Instead, it issued a statement asserting that the sexual exploitation of children “is an especially heinous crime” and that “the safety and well-being of our youth is a top priority for the FBI.”

The statement also said the many allegations against Nassar “transcended jurisdictions,” an apparent suggestion that internal efforts to coordinate among its bureaus and with other law-enforcement agencies partly explained the inquiry’s slow tempo.

The agency left unaddressed the oft-repeated claim by USA Gymnastics officials that after initially presenting the sexual-assault allegations to the FBI in July 2015, they came away with the impression that federal agents had advised them not to discuss the case with anyone. The ensuing silence had dire consequences, as the many girls and young women still seeing Nassar received no warning.

Among them was Emma Ann Miller.

By summer 2015, Emma Ann, the only child of a single mother, was a competitive dancer and just another Michigan kid immersed in the joys and dramas of middle-school life. She got braces, with baby-blue rubber bands that matched her eyes. She began receiving Snapchat attention from boys.

And once a month, she went to Suite 420 in a six-story office building close to Michigan State University in East Lansing, where her solicitous doctor, who encouraged everyone to just call him Larry, molested her.

According to her lawyer, Emma Ann had about a dozen sessions with Nassar between the summers of 2015 and 2016. The pain of the procedures increased, and her self-confidence plummeted.

“Whenever he asked if my lower back hurt, he would always find a way to touch me down there,” she said, explaining that Nassar would say that her pelvis was in need of adjustment. “Whether or not I said my back hurt, he would always find a way to, to …”

The girl paused.

“I think I’ve blocked out a lot of what he did to me,” she said finally.

Only three years ago, Nassar was a popular doctor among the athletes he treated for USA Gymnastics. His treatments were also in demand at Michigan State, where he worked, as well as at a gymnastics academy called Twistars.

Issues had cropped up: a parent raising concerns about his behavior at Twistars; a female athlete or two at Michigan State complaining to no avail about inappropriate exams. In 2014, a university investigation of another complaint cleared Nassar of misconduct, but he was now required to have a third person present when treatment involved sensitive areas of the body — and to wear gloves.

Still, the doctor was trusted enough to conduct his procedures — including one called “intravaginal adjustment” — without supervision when treating the country’s best gymnasts at the Karolyi ranch, the exclusive and secluded national team training camp, about 60 miles north of Houston. Gymnasts of international caliber, like Nichols, of suburban Minneapolis, would spend a week each month at the ranch.

There, in late spring 2015, Nichols’ personal coach, Sarah Jantzi, overheard the 17-year-old girl talking with another elite gymnast, Aly Raisman, about Nassar’s invasive and inappropriate techniques. The alarming information was quickly shared with the girls’ parents and, by June 17, with officials at USA Gymnastics.

Gina Nichols, Maggie’s mother, recalled telling Steve Penny, then the president of USA Gymnastics, that the police had to be called immediately. But he insisted that she not tell anyone, she said. The organization would take care of alerting law enforcement.

Weeks of silence passed, Gina Nichols said, although the U.S. Olympic Committee has said USA Gymnastics reported one of its physicians had been accused of abusing athletes “and was in the process of contacting the appropriate law enforcement authorities.”

USA Gymnastics eventually retained what it called “an experienced female investigator.” The investigator recommended Friday, July 24, that Nassar be reported to law enforcement.

On Monday, July 27, gymnastics officials contacted the FBI in Indianapolis, where USA Gymnastics has its headquarters. The next day, its chairman, Paul Parilla, and Penny met with FBI agents who, they later said, assured them they had come to the right place. Forty-one days had passed since USA Gymnastics first received the report of the sexual abuse of one of its charges.

The gymnastics officials provided the agents with contact information for three gymnasts: Nichols, Raisman and someone emerging as the central complainant: McKayla Maroney, then 19, a retired Olympic gold medalist.

They also turned over copies of videos of Nassar demonstrating his technique as he chatted clinically about pulled hamstrings, buttocks and trigger points. Reporters for The New York Times have seen the videos, which show him kneading the legs of girls before his ungloved hands begin to work under a towel, between the girls’ legs.

“It’s not a fun place to dig,” Nassar says to the camera.

Nassar first molested Emma Ann Miller when she was 10, she recalled. She was having back and neck issues, and he had her remove her leggings and put on loose shorts. In a medical supply room that doubled as a treatment room, he began exploring “down there.”

“He was like, ‘Is this OK?’ and I was like, ‘I don’t know,’” she said. “And he was like, ‘Just hang in there.’ I didn’t know how it felt. I just knew that it hurt.”

At some point, Emma Ann told her mother that she preferred not to be alone with Nassar. But he continued to abuse her, she said, while positioning himself so that her mother couldn’t see what he was doing. Emma Ann now knows that she was not alone.

In late July or early August 2015, FBI agents interviewed Maroney by phone. It was the first substantive interview of an alleged victim of child molestation.

Meanwhile, Nichols and Raisman had received no word from any law-enforcement official about the allegations now lodged with the FBI.

Some of the delay appears to have been related to questions concerning federal-versus-state jurisdiction, as well as jurisdiction within the FBI itself. Although the Indianapolis bureau had received the information, the alleged sexual abuse by Nassar had taken place in Texas, at the Karolyi ranch, and in Michigan, where he lived and worked. And Maroney lived in California.

According to W. Jay Abbott, who at the time was the special agent in charge of the FBI bureau in Indianapolis, his agents did not have the case for long. “When we consulted with the U.S. attorney, we knew right away that we would not have venue,” he said. “It was never really our case.”

USA Gymnastics officials said that around this time, they were told that pertinent interviews had been completed and that the case had been transferred to another jurisdiction. Indeed, on Sept. 12, Maroney was directed by USA Gymnastics to contact the FBI East Lansing office.

Two weeks later, on Sept. 27, Nassar announced on Facebook that he was retiring from the women’s national team staff.

In April 2016, Raisman shared a gold medal with the national team at the Pacific Rim Championships in Seattle, while Nichols damaged a knee during training, underwent surgery and was out for several weeks. Meanwhile, neither she nor her parents heard anything about the federal investigation that USA Gymnastics had instructed them to remain silent about.

Finally, the absence of information about the federal investigation prompted Penny and Parilla, the USA Gymnastics officials, to visit the FBI’s Los Angeles bureau in early May.

“As time passed, concern about a perceived lack of development prompted Board Chair Paul Parilla and CEO Steve Penny to report the matter a second time to a different FBI office,” USA Gymnastics said in a statement to The Times on Friday.

Through a lawyer and a spokeswoman, Parilla and Penny declined to be interviewed for this article.

On May 17, the FBI finally interviewed Maroney in person. It had been 294 days since the FBI was first notified of accusations against Nassar.

On Sept. 12, 2016, The Indianapolis Star published an in-depth investigation detailing allegations that Nassar had repeatedly molested two gymnasts when they were young.

Suddenly, the Nassar case took on urgency.

By the close of 2016, Nassar was in custody. By the close of 2017, he had been convicted. Given that he has been sentenced to nearly two centuries in prison, Nassar will likely die there.