We assessed the effectiveness of microscopic subinguinal varicocelectomy for the treatment of painful varicoceles. Patients with painful varicocele (n = 81) treated by microsurgical varicocelectomy who attended a 1-year follow-up were retrospectively evaluated. We documented patient age, grade and location of the varicocele, duration and quality of pain, and response to surgical therapy. Telephone interviews and chart reviews were conducted to assess resolution of pain, recurrence of the varicocele, and complications of the procedure. Of the patients, 29 (35.8%) described the soreness as a sharp pain, 35 (43.2%) as a pulling sensation, and 17 (21%) as a dull pain. The varicocele was grade III in 62 patients (76.5%) and grade II in 19 (23.5%). After microsurgical varicocelectomy, 74 patients (91.3%) experienced improvement in their symptoms: 58 patients (71.6%) experienced a complete resolution of pain postoperatively, and 16 patients (19.7%) experienced partial resolution. Seven patients (8.6%) experienced no change. Of the 7 patients with persistent pain, 2 patients had sharp pain, 4 patients had a pulling sensation, and 1 experienced dull pain postoperatively. The resolution of pain was correlated with preoperative varicocele grade (P = .026) but not with quality of pain (P = .807). Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicoceles.