Abstract Objectives. The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain. Methods. From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain. Results. Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound. Conclusions. Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.