Medellin is a well-designed city with an ideal climate. Prices are quite affordable compared with most worldwide destinations. The prepagos scene has good variety to keep everyone happy. Culturally sex is more conservative so you won't see the craziness apparent in locations across East Asia or Europe. El Centro area may provide a more toned-down version of Bangkok for certain individuals. If you're obviously an expat this is not the best advice.
Safety was the biggest concern by far spending a few weeks in Medellin. If you're a white guy you will stand out in a bad way. I did have some minor scuffles in my stay from very aggressive junkies after the sun set. If you are not in very good shape and sober with at least workable Spanish I would not recommend going out alone in Medellin, something I did the entire trip. Everyone from locals to larger middle-aged black American guys thought I was unwise coming alone. I always had a concern any time I was out in public anywhere in the city at any time. My astuteness and aggressive defense when junkies tried to get close I think kept me safe from a stabbing or other robbery attempt. Locals agreed it is acceptable to physically threaten street trash of which I had to do a few times, unfortunately. If you're not ready to throw hands or kicks or run at a moments notice Medellin is not the best place for a solo foreign traveler. Strolling around border towns in the evening in Mexico is a walk in the park compared to this city.
For girls the city is hard to beat in price for quality. I stuck only with casas due to the security issues. Sandalay had the hottest girls on average, followed by New Life. My favorite girl in terms of looks and pussy was Estafania at Sandalay. She was a young 20 year old girl with nice fake tits, dark skin, tight ass, and a very tight beautiful pussy. She did enjoy giving a dance to music to start the sessions. Love how the girls there walk around with barely any clothes on.
My most repeated location was New Life simply due to the large selection and lower traffic / transit area outside. Best girl there was Camilla, an early 30's spinner type who enjoys a good hard pounding. She wears glasses sometimes which gives her an exciting look. Took her a handful of times and she is surprisingly good at massage. Angel, another petite spinner, was an honorable mention.
Most sessions I took the 30 minute (media hora) option. It was 50 k COP ( 10 USD) at Sandalay and 60 at New Life ( 13 USD) which included CBJ with vaginal sex. With good girls I would take the hour option for 22 USD. You are not pressured to drink, buy girls drink, eat, or upsell on services in the room. Never once did I have any pressure or had any bullshit pulled by staff or the girls. Also nicer than Mexico in that all positions and full nude are included in the same price. Never understood why in Mexico girls want another 5 USD for a different position or clothing configuration. No such games in Colombia.
I'm not sure about ever returning, at least solo, outside of a need for a quick romp trip. The location is ideal if a US citizen is located near a major international transit hub into Latin America. For a quick trip you can stomp through several girls in short order and make a quick flight back home. Prices are unbeatable in most places across the world for the quality, to my knowledge and experience. It's not nearly as fun as any other known destination, including Tijuana, as it's difficult to enjoy with all the robberies and druggings going on.
If the security questions were adequately addressed the place could become a top destination. Staying in very nice hotels in a safe neighborhood still won't get you away from the violence as there were multiple shootings right outside the hotel during my stay. The girls are quite sweet, no big egos or bad attitudes, and many shapes and sizes to choose from. The normal people were quite friendly and docile. It is a land of stark contrasts and hope they figure it out. Very rarely do I leave a hotspot without some some longing to stay for more and withdrawals after getting back, but I have not longed for Medellin since heading to the airport. Only other place I felt somewhat similar was the Philippines but still enjoyed that place heavily to Colombia. Good news is if you can make it in Colombia you can supposedly make it anywhere in Latin America. I'm not sure how people put up with that shit and live in that type of environment. Most don't know anything different.