The complexity of female orgasm and ejaculation.

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

Reflexión sobre la educación médica en Colombia / Reflections on medical education in Colombia

Este artículo presenta un panorama del avance de la educación médica en Colombia, a partir del trabajo conjunto entre la academia, los gremios relacionados con la educación médica y el gobierno a través de los ministerios de Educación Nacional y de Salud y Protección Social como entes rectores de la profesión. Las situaciones a abordar en el campo de la educación médica son la proporción de médicos por habitantes, la equidad en el acceso a médicos especialistas en las diversas zonas del país, las competencias de los médicos generales para actuar en el esquema de atención primaria y una baja demanda de posgrados médicos. Se presentan algunos datos del estado actual de la educación médica en el país, la experiencia de creación de la Facultad de Medicina de la Universidad del Valle, las recomendaciones de la Comisión para la Transformación de la Educación Médica en Colombia y la postura ante ellas de los ministerios mencionados. Colombia avanza hacia la construcción de escenarios deseables en la educación médica en conjunto con los entes gubernamentales, lo que posibilita una serie de acciones alrededor del contexto, el entorno, el individuo, el aprendizaje, las estrategias educativas, los recursos educacionales y la evaluación

This article presents an overview of the advances made in medical education in Colombia, based on the joint work carried out among the academia, medical education associations and the government through the Ministries of National Education and of Health and Social Protection as the bodies governing the profession. Situations to be addressed in the field of medical education include the ratio of the number of physicians to the number of inhabitants, equity in access to specialist doctors in the different areas of the country, the competences of general practitioners to work within the field of primary care and the low demand for postgraduate medical degrees. We present some data on the current state of medical education in the country, the experience of the creation of the Faculty of Medicine of the Universidad del Valle, the recommendations of the Commission for the Transformation of Medical Education in Colombia and the position taken by the aforementioned ministries with regard to them. Colombia is moving towards the construction of desirable scenarios in medical education in collaboration with government agencies, and this makes it possible to implement a series of actions concerning the context, the environment, the individual, learning, educational strategies, educational resources and evaluation

Medicina de Família e Comunidade, Atenção Primaria e Violência: Formação e ação em Iberoamerica / Family Medicine, Primary Care and Violence: Training and action in Iberoamerica / Medicina de Família e Comunidade, Atenção Primaria e Violência: Formação e ação em Iberoamerica

Objetivo: Identificar la percepción de médicos de familia y comunidad, así como de otros profesionales de Atención Primaria, en los 20 países que conforman la Confederación Iberoamericana de Medicina de Familia (CIMF), sobre las formas de violencia más prevalentes en su país y en las comunidades que asisten. Además, identificar la percepción sobre sus propias capacitación y motivación, además aquellas de los médicos de familia en sus países, para abordar la violencia y contribuir a la cultura de la paz. Métodos: Estudio exploratorio, corte-transversal, de carácter descriptivo y enfoque cuantitativo, realizado en los 20 países miembros de CIMF, entre los meses de septiembre de 2017 a marzo de 2018. Se construyó un instrumento tipo encuesta, a partir de revisión bibliográfica del fenómeno de estudio, discusión y validación con diferentes profesionales de la medicina familiar considerados expertos en el tema. Se divulgó con el apoyo de las diferentes sociedades científicas de Medicina Familiar que componen los 20 países de CIMF, alcanzando 242 respuestas. Resultados: Más del 92% de profesionales consideran carecer de formación suficiente para abordar la violencia en su cotidianidad laboral y solo 24% considera haber recibido formación suficiente en la Cultura de Paz. Por otro lado, es alarmante en la región la percepción de prevalencia de los diversos tipos de violencia desde el punto de vista personal, familiar y comunitario. Conclusiones: Es necesario integrar en la formación de los médicos familiares y profesionales de la Atención Primaria, asimismo en los currículos de pregrado de Medicina, contenidos relacionados con el abordaje de la violencia y la contribución a la cultura de paz para superar la violencia. Es visible la brecha de conocimiento en estos temas por parte de los médicos de familia y demás profesionales que actúan en la Atención Primaria. Por otro lado, es notable el potencial beneficio de tener esos profesionales actuando en esto grave problema de salud por su elevada prevalencia y especialmente considerando su contacto frecuente y longitudinal con las personas, familias y comunidades quienes han sido víctimas de violencia.

Objective: To identify the perception of family and community doctors - as well as other professionals in 20 countries that make up the Ibero-American Confederation of Family Medicine (CIMF) - on the most prevalent forms of violence in their country and in the communities they attend. Also, to identify the perception about their own motivation and ability, as well as that of family physicians from their countries, to address violence and contribute to the culture of peace. Methods: Cross-sectional, exploratory study, descriptive and quantitative approach, carried out in the 20 member countries of CIMF, between the months of September 2017 to March 2018. A survey was designed based on a literature review of the study phenomenon, discussion and validation with different family medicine professionals considered to be experts in the subject. It was disseminated with the support of the different scientific societies of Family Medicine that make up the 20 countries of the CIMF, reaching 242 responses. Results: More than 92% of professionals consider that they lack sufficient training to deal with violence in their daily work and only 24% consider that they have received sufficient training in the Culture of Peace. On the other hand, the perception of prevalence of the different types of violence from the personal, family and community point of view in the region is alarming. Conclusions: It is necessary to integrate in the training of family doctors and primary care professionals, as well as in the undergraduate curricula of Medicine, contents related to the approach to violence and the contribution to the culture of peace to overcome violence. The knowledge gap on these issues is visible by family doctors and other professionals who work in Primary Care. On the other hand, the potential benefit of having these professionals acting in this serious and prevalent health problem is remarkable, especially considering their frequent and longitudinal contact with people, families and communities who have been victims of violence.

Objetivo: Identificar a percepção de médicos de família e comunidade, bem como outros profissionais, em 20 países que compõem a Confederação Ibero-americana de Medicina de Família (CIMF), sobre as formas mais prevalentes de violência em seu país e nas comunidades que atendem. Além disso, identificar a percepção sobre suas próprias motivação e capacitação, além daquelas dos médicos de família de seus países para abordar a violência e contribuir para a cultura da paz. Métodos: Estudo corte-transversal, exploratório, de abordagem descritiva e quantitativa, realizado nos 20 países membros da CIMF entre os meses de setembro 2017 a março de 2018. A pesquisa foi projetada com base em uma revisão da literatura sobre o fenômeno de estudo. Um questionário foi elaborado e validado com diferentes profissionais de medicina de família considerados especialistas no assunto e posteriormente disseminado com o apoio das diferentes sociedades científicas de Medicina de Família que compõem os 20 países do CIMF, alcançando 242 respostas. Resultados: Mais de 92% dos profissionais consideram que não possuem treinamento suficiente para lidar com a violência em seu cotidiano de trabalho e apenas 24% consideram que receberam treinamento suficiente na Cultura de Paz. Por outro lado, a percepção da prevalência, na região, dos diferentes tipos de violência, do ponto de vista pessoal, familiar e comunitário é alarmante. Conclusões: É necessário integrar na formação de médicos de família e os profissionais de cuidados primários, bem como nos currículos de graduação de Medicina, conteúdos relacionados com a abordagem à violência e a contribuição para a cultura da paz para a superação da mesma. A lacuna de conhecimento sobre essas questões é visível pelos médicos de família e outros profissionais que trabalham na Atenção Primára. Por outro lado, é notável, o benefício potencial de ter esses profissionais atuando nesse grave e prevalente problema de saúde, especialmente considerando seu contato frequente e longitudinal com pessoas, famílias e comunidades vítimas de violência.

Correlates of sexuality in men and women aged 52-90 years attending a university medical health service in Colombia.

INTRODUCTION: Limited information is available regarding sexuality among Colombian adults aged 50 years and older. AIM: To assess demographic or health characteristics associated with sexuality measures among middle- and older-aged men and women. METHODS: Cross-sectional face-to-face interviews were conducted with retired persons from a university ambulatory medical care setting. Data on sexuality were obtained along with data on their demographic, emotional intimacy, practice of religion, medical conditions, and functional health measures. There were 136 participants. MAIN OUTCOME MEASURES: Appropriateness of sex, sexual desire, importance of sex, masturbation, and sexual intercourse. RESULTS: Fifty-seven percent of the participants were over 65 years of age, 52% were female, and 66% reported being married; 67% indicated sex is appropriate, 58% reported having sexual desire, 45% considered sex very important in their lives, 54% reported one or more instances of sexual intercourse, and 16% reported masturbating within the last year. In multivariate analyses, importance of sex and sexual intercourse decreased by age. Women had decreased odds ratios (0.20 to 0.33) for sexuality measures compared with men with the exception of appropriateness of sex. Married persons had increased odds ratios (3.06 to 9.45) for importance of sex, appropriateness of sex, and sexual intercourse compared with those of the same age who reported being unmarried. Other factors associated with some particular sexuality measures were emotional intimacy, religious practice, medical conditions, and functional health measures. There were significant mediation effects for appropriateness of sex on the relationship between sexual desire and sexual intercourse, and for importance of sex on the relationship between appropriateness of sex and sexual intercourse. CONCLUSIONS: Men and married persons had higher rates of most sexuality measures compared with women or their unmarried counterparts. These differences were greater at older ages (> or =65) for all sexuality measures except sexual intercourse.

Mantenimiento de la salud del adolescente / Maintenance of the health in adolescents

Se realizó un estudio descriptivo sobre mantenimiento de la salud en 138 adolescentes del Distrito de Agua Blanca, Calí Colombia, en 1994. Se evaluaron parámetros en el área biopsicosocial. La edad promedio de los adolescentes fué de 13,5±3,5 años, el 53 por ciento fueron mujeres, encontrándose el 63 por ciento de ellos en adolescencia intermedia. Se observó que 22 (16 por ciento) adolescentes presentaban desnutrición crónica (relación talla/edad < percentil 5), 33 (24 por ciento) se observaron con problemas de refracción ocular mediante valoración de agudeza visual, y 117 (85 por ciento) se les detectó caries dental. Las familias eran nucleares en 76 (55 por ciento) adolescentes, eran extensas en 22 (16 por ciento) y convivían con un solo padre 24 (17 por ciento). Al evaluar la funcionalidad familiar se observó disfunción familiar (APGAR familiar< 18 pts, rango 0-20 pts) en 123 (89 por ciento) adolescentes evaluados. El área de funcionalidad familiar donde se observó mayor grado de insatisfacción fué con el afecto que le proporciona la familia al adolescente (57 por ciento) y la adaptación ante las situaciones de estrés familiar (54 por ciento). El 48 por ciento de los adolescentes se les observó riesgo de farmacodependencia. La evaluación del desempeño académico demostró un buen rendimiento escolar en 91 (66 por ciento) adolescentes, regular rendimiento académico en 30 (22 por ciento) y mal rendimiento académico en 17 (12 por ciento) adolescentes. Se observó una asociación estadísticamente significativa entre la disfunción familiar y el riesgo de farmacodependencia (OR=4.51, ic. 95 por ciento 1.45 - 16.56, x2=8.62, p<0004).