PURPOSE: To compare pre-and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches and to identify the factors that affect the outcomes. MATERIALS AND METHODS: A total of 48 patients with left-sided varicocele who had left scrotal pain was included and followed up for more than 3 months. Twenty patients underwent varicocele ligation using modified Palomo, fifteen with laparoscopic approach and thirteen with microscopic subinguinal varicocelectomy respectively. Visual pain scale was used at pre-operation and 3 months later postoperatively. We compared age, grade, a character of pain, operation time, a number of pain killer and pain score. RESULTS: Mean age of patients was 28.9 years (range 15~58 years). 45 patients described their pain as dull ache and 3 as a sharp sensation. There was complete resolution of pain in 35 patients (72.9%), while 7 (14.5%) had partial resolution. 6 (12.5%) had persistent symptoms and varicocele recurred in 3 (6.2%). There was no significant difference in pain resolution according to surgical approaches. Microsurgical approach had a prolonged operation time, but recurrence was not occurred. 3 patients that had a sharp scrotal pain were included in partial resolution or persistent pain. CONCLUSIONS: Surgical approaches were effective in the treatment of painful varicocele in selected patients and there was no significant difference in pain resolution according to surgical approaches. The sharp scrotal pain was related to the outcome of treatment.