Living Together, Loving Apart: Health, Sexuality and Relationships in Middle‐Aged and Older Men in Europe

Background: Over time, family structures have grown more complex, diversifying adult relationships. While research has compared marital, cohabiting and living apart together relationships based on quality and health, less is known about their sexual dynamics. Theoretical frameworks suggest that co-resident relationships may integrate sexuality differently from living apart together unions, where physical separation can either strengthen or weaken sexual intimacy. This study addresses this gap by analysing sexual function and satisfaction among men in marital, cohabiting and living apart together relationships. Exploring the relationship between living apart together unions and sexual and hormonal aspects can enhance our understanding of the links between hormones and the social and relational dynamics of contemporary society. Methods: We analysed cross-sectional data from the European Male Ageing Study, a non-interventional cohort study conducted in eight European countries from 2005 to 2008. The sample included 3259 men aged 40-79 years who reported their relationship status. Sexual function was evaluated using the validated European Male Ageing Study sexual function questionnaire. Hormonal, lifestyle and health indicators were also collected. Statistical analyses, including ANCOVA, were used to adjust for confounders such as age, education, lifestyle and comorbidities. Results: Living apart together relationships were reported by 6.9% of the cohort, similar to the 7.0% in cohabiting relationships, while 86.0% were married. Living apart together men were younger, more educated, and had a higher prevalence of smoking compared to married men. Compared to those in co-residential relationships, men in living apart together relationships showed higher levels of free testosterone, greater sexual desire and satisfaction, and increased frequency of sexual activity, morning erections and masturbation. Cohabiting men were in an intermediate position, with married men reporting the lowest sexual desire and activity. Conclusions: Our findings align with previous research, suggesting that living apart together relationships are associated with higher levels of sexual function and satisfaction. However, this is observed without the broader benefits of co-residence, such as emotional security, shared responsibilities and partner's health oversight. Further research is needed to clarify the interplay between relationship type, sexual and health well-being.