Approximately 20 million ha of agricultural land worldwide are irrigated with wastewater. Additionally, the WHO states that 10% of the world’s population is consuming food from wastewater irrigated farmland. According to the WHO, the use of wastewater for agricultural irrigation will only increase in order to cope with water stress. One the one hand using wastewater for irrigation saves surface and ground water of natural ecosystems and saves fertilizer because of its natural nutrients. On the other hand, untreated wastewater causes environmental and social harm as it can be contaminated with heavy metals and pathogens. Aiming at assessing the economic, ecologic and social impact of wastewater irrigation this studies first systematically identifies more than 40 empirical studies on sustainability assessment for save use or reuse of wastewater in agriculture. Second, this studies are content analyzed to identify sustainability assessment methods, impact categories along all three dimensions of sustainability and matching indicators. The literature review indicates there is no assessment study which analyses all three dimensions. Therefore, this study will fill this gap by developing a sustainability assessment method for save use of wastewater in agricultural irrigation accounting for and evaluating all three dimensions. This methodology will be applied to the greatest wastewater irrigated region in the world, Mezquital, to evaluate the consequences of using untreated wastewater compared to treated wastewater irrigation and irrigation with natural water resources. Thereby positive and negative effects of wastewater irrigation is assessed along the three dimensions of sustainability.