Access to sexual activity improves survival. (A) Schema of heart failure stages, biomarkers, systolic function and mortality in male dilated cardiomyopathy (DCM) mice [12,19,21]. Ejection frication (EF); Atrial and B-type natriuretic peptide (ANP and BNP). (B) Kaplan–Meier survival curves for DCM mice under all different conditions: DCM mice with (DCM+S) or without access to sexual interactions (DCM-S), with normal diet (ND) or breeding diet (BD), with or without pups in the cage, with or without a cage divider, and with separation and shifting to other cages. (C–H) Relevant pairwise comparisons of Kaplan-Meier survival curves (from panel B) for DCM mice under different conditions. (C) DCM mice with access to sexual interactions with females on a breeding diet (DCM+S, BD, n = 32) vs. DCM mice without access on a normal, non-breeding diet (DCM-S, ND, n = 35). (D) Effect of diet on survival, DCM-S on a normal diet (DCM-S, ND, n = 19) vs. DCM-S on breeding diet (DCM-S, BD, n = 22). (E) DCM mice with or without sexual interactions on the same breeding diet. (F) Effect of co-housing with pups: DCM+S cohoused with pups (n = 32) vs. DCM+S housed without pups (n = 10). (G) Effect of co-housing with females without sexual activity: DCM-S (n = 10) mice co-housed with female mice with sexual activity restricted by porous cage dividers between male and female mice, see S1B) vs. DCM+S (n = 32) in which sexual interactions were not restricted. (H) Effect of terminating sexual interactions with females: DCM-S (n = 35) without continuous access to sexual interactions with females vs. DCM+S in which sexual access was terminated by transfer to non-breeding cages at 13 weeks of age (n = 11). Survival of control mice without DCM was normal and consistent with wild-type C57BL6/J mice.