But I bet it makes it a lot harder and more time-consuming to cover all the different branching pathways and possibilities, right? That's presumably why most devs don't bother (or dabble in very light ways, like Man of the House). It seems like having these more realistic options would increase the complexity exponentially.
Whether it increases the complexity much depends on the game design.
Take for instance Our Fate: it has two very different paths (love vs corruption) and within these main paths different goals (love: pursue relationship or just be a good father) as well as smaller, less significant choices (which girls you want to pursue or not).
Yet, the game uses mostly the same renders for all paths. The text however is vastly different.
To me, this solution is not so perfect (e.g. on corruption path, you could expect different clothes and postures), BUT given that most devs have only limited time available for game development, it is a reasonable choice.
The biggest downside to doing a lot of paths is that there is a lot of art that most people will never see.
But in in my opinion, a game without meaningful choices is more like a kinetic novel, and for me it takes a huge part of the enjoyment away. It is what differentiates a game from regular porn.