<p>The use of online pornography is widely prevalent among adolescents. This study presents a systematic review and meta-analysis to explore the relationship between online pornography use and psychopathological symptoms in this population. The study was conducted in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search was conducted in PubMed, Scopus and Web of Science for studies published between 2005 and 2024. Eligible studies included quantitative research examining the association between online pornography use and psychopathological symptoms as defined by the DSM-5-TR, with samples comprising adolescents aged 10–19 years. Fourteen studies were included in the systematic review, and twelve were incorporated into the meta-analysis. The meta-analyses revealed a moderate positive correlation between online pornography use and psychopathological symptoms among adolescents. Subgroup analyses indicated no significant differences based on gender. The findings suggest that, in its most problematic manifestations, online pornography use among adolescents may serve as a maladaptive coping strategy for managing underlying distress. An empathetic approach with adolescents displaying problematic online pornography use has the potential to improve the outcomes of therapeutic interventions. These interventions might enhance adolescents’ personal and relational resources, thus facilitating the discovery of healthier alternatives that effectively address their psychological needs.</p>