Bolton made his tortured liege, Sansa's childhood friend Theon Greyjoy, watch.
The scene has been defended by the show's creators, actors, and writer GRR Martin, under an avalanche from critics, who can be summed up by this headline from Variety: "Game of Thrones missed the mark in a big way this week."
Twitter, which has long documented the shock and awe of Thrones viewers, took a dark turn as audiences reacted to the brutality of the scene.
Others also complained about how the TV portrayal differed from the books:
In the books, Ramsay's bride is Jeyne Poole, a Northerner and former friend of Sansa's who is forced to pretend to be the long-lost Arya Stark, to help cement the Boltons's claims to Winterfell and the North.
She is humiliated and tortured by Ramsay (at one point, it's even implied that she has been forced to copulate with a dog, although this isn't directly shown).
Meanwhile, Sansa Stark remains with Littlefinger, learning, observing and moving away from being a victim, and into something more complex. (Moving from a pawn to a player, to borrow Littlefinger's own term).
In the recent preview chapter from George RR Martin's next book, The Winds of Winter, we are shown a Sansa who seemed both more cynical, and more sophisticated.
As illustrated above, many fans are angry that, rather than continuing to allow Sansa to grow, the programme-makers have instead decided to switch her character with Jeyne's, and again subject her to indignity and horrific violence.
A similar furore sprung up during the episode Breaker of Chains in season four, when a consensual sex act between Cersei and her brother Jaime Lannister from Martin's books was made non-consensual in the TV adaptation.
In an interview with Entertainment Weekly, the actress who plays Sansa, Sophie Turner, and producer Bryan Cogman, defended the scene.
Contrary to accusations that Thrones characters have moved Sansa's character development back several years, Cogman replied that she was "a hardened woman making a choice and she sees this as the way to get back her homeland".
"Sansa has a wedding night in the sense she never thought she would with one of the monsters of the show. It's pretty intense and awful and the character will have to deal with it."
He added that he would never have considered involving Theon in the adaptation, who was part of a similar wedding night scene in Martin's A Dance With Dragons.
"It's still a shared form of abuse that they have to endure, Sansa and Theon," Cogman said, "but it's not the extreme torture and humiliation that scene in the book is."
Meanwhile, Turner, 19, has caused controversy by saying that she "kinda loved" the scene.
She said: "When I read that scene, I kinda loved it. I love the way Ramsay had Theon watching. It was all so messed up. It's also so daunting for me to do it."
She added: "I love the fact [Sansa's] back home reclaiming what's hers. But at the same time she's being held prisoner in her own home.
"When I got the scripts, it was bit like, dude, I felt so bad for her. But I also felt excited because it was so sick, and being reunited with Theon too, and seeing how their relationship plays out."
The actor who plays Bolton, Iwan Rheon, told Vulture the scene was "a really horrible thing to talk about".
"All I'm going to say is I don't think he's a particularly generous or gentle lover."
Alfie Allen, who plays Greyjoy, had warned viewers the scene would shock viewers.
"There's something that happens about halfway through this season that is really going to make huge waves. And people aren't going to be happy about it. It's hard to watch," Alfie told website Zap2it.
"I bear witness to this thing, and it's crazy, sort of having to portray how messed up everyone's situation is through my own reactions to what happens," he added. "Get ready for it."
In a lengthy blog post, Martin addressed the issue of the TV show differing from the books.
"There have been differences between the novels and the television show since the first episode of season one. And for just as long, I have been talking about the butterfly effect. Small changes lead to larger changes lead to huge changes," he said.
"HBO is more than forty hours into the impossible and demanding task of adapting my lengthy (extremely) and complex (exceedingly) novels, with their layers of plots and subplots, their twists and contradictions and unreliable narrators, viewpoint shifts and ambiguities, and a cast of characters in the hundreds ...
" ... we have reached the point where the beat of butterfly wings is stirring up storms, like the one presently engulfing my email. "
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