“It came on suddenly playing football”

Sudden, severe testicular pain with nausea/vomiting in an adolescent is testicular torsion until proven otherwise — a time-critical surgical emergency where the chance of salvage falls with every hour of ischaemia and is best when the testis is untwisted within a few hours of onset (EAU paediatric urology guideline, international — there is no UK guideline). The only safe action is IMMEDIATE emergency assessment (999/ED, urgent urology/surgery); there is no role for "watch and wait", a routine appointment, waiting for analgesia, or a scan that delays surgery. The classic trap is the "pulled muscle/knock from football" label — exertion is a torsion trigger, and absence of fever argues against infection. The examinable hidden agenda is the dangerous barrier of the teenager’s embarrassment and the parent’s minimising; the skill is to overcome these fast and sensitively — speak to the young person directly with dignity, normalise it, convey urgency without panic, and get them moving now, nil by mouth, with a clear safety-net (pain easing does not mean resolved; intermittent torsion re-twists).