Are you aware that DC's account was suspended by Patreon for several months about 6 years ago for the original storyline that had Debbie, Jenny, and the MC related to each other and with Diane? The suspension also involved the original setting of it being a high school, as well as the nonconsensual sleep-sex by the MC with Jenny.
In order for DC to keep his Patreon account, he had to edit the script to change the relationships (players can rename Jenny and Debbie - but the script does not change when they do that), he had to change the setting to a college, and he had to alter the bed sex with the MC and Jenny. Patreon had to approve the changes before DC's suspension was lifted. He probably does not want to attempt to push the line and risk his Patreon account. Other developers have (see a few recently who had been warned/suspended in the past at least once, who had their Patreon accounts removed this spring because they pushed the line one too many times).
If there are developers on Patreon who allow players to change the relationship of the characters and that alters the script (so that the script has alternate coded data) - they may be in violation of the TOS/Guidelines but have not been reported yet for Patreon to review. If they simply have "what is XXXXX's name?" but nothing in the script changes, that most likely follows the guidelines. Also, developers who make patches to provide Patreon prohibited content are violating TOS/Guidelines and, should they get reported, they may find they will have to stop doing so or find their account removed.