Discharge of sewage to the environment in the form of treated or untreated wastewater can have serious impacts on human health and quality of life and on ecosystem condition. Since a previous review in 1997, upgrades to wastewater treatment facilities, along with improved source control, have produced successes in reducing loadings of certain pollutants (e.g., mercury, polychlorinated biphenyls) to Canadian waters. However, nationally, loads of phosphorus discharged from wastewater treatment facilities have not changed in recent years (2003–2008), and releases of nitrogen have increased slightly. In some locations, wastewater discharges are contributors to bacterial contamination, toxicity from heavy metals and ammonia, and eutrophication, all of which continue to threaten public and environmental health. An increasing number of studies are also demonstrating developmental, reproductive, and behavioural changes in fish and other aquatic organisms from exposure to pharmaceuticals, personal-care products, or other pollutants in domestic wastewater, even after treatment. Minimizing wastewater discharge and mitigating its effects on the environment and human health will be a challenge. It is critical that gains achieved by improved wastewater treatment and other control measures not be reversed by relaxation of efforts or by failure to keep pace with population growth.