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I mean technacally u can play without the incest patch, but lets be real. Its still incest. From my knowledge u only have to date one sister. everyone else is optional and there is people that are not related to the MC, that u can date. But they come later on in the game. But no matter what u have to date Sandra, but the rest of the family u can choose not to date...
the only change in dialouge is what they are to u. I think its like ummm, your mom is landlady, and your sisters is roomates i believe. Have never played it myself cause i do like the incest aspect. I dont know what your cousin or aunt is called, but then again u do only have to date 1 family member...