Regarding the customization, I hear ya to an extent, though some of the optional features work (turning 'hairiness' on or off for example).
As for things like urethral sex, I made custom items that changed the bodies of defeated opponents, and you can then change them by forcing them to use the items. Tightness needs to be above 0, etc., but the option does work, and you can simply change yourself if you want to be on the receiving end...
Custom items can also give or remove the opponents' fetishes. To streamline things, I got stacks of the 'Flowers' and 'Teddy Bear' gifts and manually edited my save to have the transformations and fetishes I wanted my opponents to have (make a potion, then copy the transformations and fetishes to the gift entry; not rocket surgery, but it takes some trial and error). Then once you win, force them to smell the roses or hug the bears (one at a time, or the whole stack). Lets me get my itch scratched the way I prefer a little easier.