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Direct discharges of treated and untreated wastewater are important sources of nutrients to coastal marine ecosystems and contribute to their eutrophication. Here, we estimate the spatially distributed annual inputs of phosphorus (P) and nitrogen (N) associated with direct domestic wastewater discharges from coastal cities to the Mediterranean Sea (MS). According to our best estimates, in 2003 these inputs amounted to 0.9 x 10 9 mol P yr −1 and 15 x 10 9 mol N yr −1 , that is, values on the same order of magnitude as riverine inputs of P and N to the MS. By 2050, in the absence of any mitigation, population growth plus higher per capita protein intake and increased connectivity to the sewer system are projected to increase P inputs to the MS via direct wastewater discharges by 254, 163, and 32% for South, East, and North Mediterranean countries, respectively. Complete conversion to tertiary wastewater treatment would reduce the 2050 inputs to below their 2003 levels, but at an estimated additional cost of over €2 billion yr −1 . Management of coastal eutrophication may be best achieved by targeting tertiary treatment upgrades to the most affected near-shore areas, while simultaneously implementing legislation limiting P in detergents and increasing wastewater reuse across the entire basin