Dominique Pelicot pleaded with his former wife, and their three children, for forgiveness during his testimony.
"Today I maintain that, along with the other men here, I am a rapist," Pelicot told the court. "They knew everything. They can't say otherwise."
While he previously confessed to investigators, the court testimony will be crucial for the panel of judges to decide on the fate of some 50 other men standing trial alongside him.
Many deny having raped Gisele Pelicot, saying they were manipulated by her then-husband or claiming they believed she was consenting.
After days of uncertainty due to his medical state, Dominique Pelicot appeared in court in Avignon, southern France, on Tuesday and told judges he acknowledged all the charges against him.
Expressing remorse, his voice trembling and at times barely audible, he sought to explain events that he said scarred his childhood and planted the seed of vice in him.
"One is not born a pervert, one becomes a pervert," Pelicot told judges, after recounting, sometimes in tears, being raped by a male nurse in hospital when he was nine and then being forced to take part in a gang rape at age 14.
A security agent caught Pelicot in 2020 filming videos under women's skirts in a supermarket, according to court documents.
Police searched Pelicot's house and electronic devices, and found thousands of photos and videos of men engaging in sexual acts with Gisele Pelicot while she appeared to lie unconscious on their bed.
With the recordings, police were able to track down a majority of the 72 suspects they were seeking.
Gisele Pelicot and her husband of 50 years had three children. When they retired, the couple left the Paris region to move into a house in Mazan, a small town in Provence.
When police officers called her in for questioning in late 2020, she initially told them her husband was "a great guy", according to legal documents. They then showed her some photos. She left her husband and they are now divorced.
He faces 20 years in prison if convicted. Besides Pelicot, 50 other men, aged 26 to 74, are standing trial.
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