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Coastal tourism is a growing industry sector in the Mediterranean Basin. This and the other human activities occurring along the coastline share space and resources, leading to conflicts for divergent uses. Moreover, the overexploitation of natural resources degrades and depletes coastal habitats, with negative feedback effects for all human activities. Hence, both tourism and the other human activities have to consider their dependence on coastal ecosystem services, and act at technical and policy level to reach a compromise that preserves natural resources in the long term. Here we provide a conceptual framework illustrating the complex relationships and trade-offs among threats from coastal tourism and from other human activities and coastal ecosystem services, with a focus on cultural ones. We discuss the negative feedbacks on tourism development and provide examples of geospatial analysis on cumulative threats generated by other human activities and affecting tourism itself. The proposed conceptual framework and the threat analysis aim at highlighting the negative feedback effects of human driven threats on the development of Mediterranean coastal tourism, through an ecosystem service perspective. Both tools provide valuable insight for supporting decision makers and planners in achieving integrated coastal management, with a focus on sustainable tourism.