Visual erotica (i.e., pornography) consumption can affect various facets in romantic relationships, including sexual behaviors, relationship satisfaction, sexual desire, communication, and partner autonomy. This literature review examines the positive and negative effects of such consumption on romantic relationships, and surveys available research on treatment goals, intervention strategies, and therapeutic approaches for working with romantic couples presenting with pornography consumption as a primary concern. Relevant relationship factors within heterosexual romantic couples are evaluated, including sexual satisfaction, well-being, and romantic relationship quality. Findings summarized suggest that treatment for partners’ sexually explicit usage behaviors should include considerations for the negative impact of sexual satisfaction and overall quality of the romantic relationship. This review supports the need for continued research to further understand how pornography consumption can affect romantic relationships, and to further identify specific evidence-based treatment methods for working with romantic partners in clinical settings.