Is ‘living apart together’ a real advantage for patients consulting for sexual dysfunction? A cohort study

Background: Quantitative research on families has introduced a new category of relationship called living apart together, that is, when a couple in a committed relationship live in separate homes. This study aimed to confirm whether living apart together improves sexual relationships in those suffering from sexual dysfunction. Methods: This study comprised cross-sectional (N = 4852) and longitudinal (N = 1402) analyses. The former explored psychobiological, hormonal and relational correlates using the Structured Interview on Erectile Dysfunction scale. The latter assessed the occurrence of major adverse cardiovascular events in a subset of patients followed for 4.3 ± 2.59 years. Results: Compared to cohabiting couples, patients in living apart together relationships were younger and characterised by higher education levels, healthier lifestyles and lower comorbidity burdens (all p < 0.001). After adjusting for those confounders, the living apart together group reported better sexual functioning, more frequent sexual intercourse, and higher total testosterone levels (p < 0.001), and the relationship was often a source of conflicts within the familial context and of shorter duration (all p < 0.05). When total testosterone was included in a fully adjusted analysis of covariance, the difference in obtaining a full erection between cohabiting and living apart together relationships became non-significant (p = 0.086), suggesting a hormonal influence on erectile dysfunction. In the longitudinal analysis, Cox models adjusted for the aforementioned confounders showed that living apart together relationships are associated with a twofold greater risk of major adverse cardiovascular events than cohabiting relationships, independent of other risk factors, including total testosterone levels, waist circumference and pathological penile blood flow. Discussion: This study illustrates that partnership arrangements can shape sexual interest and complaints, as reported by the participants. While men involved in living apart together relationships show an ostensibly healthier phenotype, they experienced more often major adverse cardiovascular events. Therefore, co-residential relationship appears to provide more effective protection against future major adverse cardiovascular events for the male partner than a living apart together relationship.